Provider Demographics
NPI:1508098088
Name:RANEY, PEGGY VIRGINIA (RD, LD)
Entity Type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:VIRGINIA
Last Name:RANEY
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14678 LYRIC RD
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77302
Mailing Address - Country:US
Mailing Address - Phone:281-799-5536
Mailing Address - Fax:
Practice Address - Street 1:8000 HWY 242
Practice Address - Street 2:SUITE 123
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77365
Practice Address - Country:US
Practice Address - Phone:936-441-3133
Practice Address - Fax:936-321-3232
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-17
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDR04966133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered