Provider Demographics
NPI:1396015327
Name:FENNELL, NICOLE SHAY (MS, RDN, LD)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:SHAY
Last Name:FENNELL
Suffix:
Gender:F
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 E TC JESTER BLVD STE 135
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-1454
Mailing Address - Country:US
Mailing Address - Phone:713-800-2987
Mailing Address - Fax:
Practice Address - Street 1:4530 BRIAR HOLLOW PL
Practice Address - Street 2:#120
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-9750
Practice Address - Country:US
Practice Address - Phone:512-635-4417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-06
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133NN1002X133NN1002X
133VN1005X133VN1005X
113VN1006X133VN1006X
TX133V00000X133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic