Provider Demographics
NPI:1457247751
Name:CHURCHMAN, MARY (RD, LDN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:CHURCHMAN
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 251754
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-1517
Mailing Address - Country:US
Mailing Address - Phone:502-600-0004
Mailing Address - Fax:
Practice Address - Street 1:1400 PRESTON RD STE 400
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5189
Practice Address - Country:US
Practice Address - Phone:502-600-0004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-16
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT92237133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered