Provider Demographics
NPI:1508266875
Name:BALLOW, CRISTIE (RD, LD, CDE)
Entity Type:Individual
Prefix:MRS
First Name:CRISTIE
Middle Name:
Last Name:BALLOW
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4304 BRENDA DR
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-1000
Mailing Address - Country:US
Mailing Address - Phone:469-438-5534
Mailing Address - Fax:
Practice Address - Street 1:4304 BRENDA DR
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-1000
Practice Address - Country:US
Practice Address - Phone:469-438-5534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-24
Last Update Date:2014-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT04850133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered