Provider Demographics
NPI:1427027739
Name:FRYE, DENISE (NUTRITIONIST)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:FRYE
Suffix:
Gender:F
Credentials:NUTRITIONIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 WOODBINE PLACE
Mailing Address - Street 2:#775
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75608
Mailing Address - Country:US
Mailing Address - Phone:903-757-8194
Mailing Address - Fax:903-757-8294
Practice Address - Street 1:107 WOODBINE PLACE
Practice Address - Street 2:#775
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75608
Practice Address - Country:US
Practice Address - Phone:903-757-8194
Practice Address - Fax:903-757-8294
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT03790133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX004781301Medicaid
TX004781302Medicaid