Provider Demographics
NPI:1407469711
Name:FORD, COURTNEY KAY (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:KAY
Last Name:FORD
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 HONSINGER ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-3712
Mailing Address - Country:US
Mailing Address - Phone:281-818-7853
Mailing Address - Fax:
Practice Address - Street 1:3410 HONSINGER ST UNIT A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-3712
Practice Address - Country:US
Practice Address - Phone:281-818-7853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-26
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT85464133V00000X
TX86104808133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered