Provider Demographics
NPI:1518987767
Name:MCCLESKEY, MARSHA E (RD/LD, MS, CDE)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:E
Last Name:MCCLESKEY
Suffix:
Gender:F
Credentials:RD/LD, MS, CDE
Other - Prefix:
Other - First Name:MARSHA
Other - Middle Name:ANN
Other - Last Name:MCCLESKEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3308 WENDOVER CT
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021
Mailing Address - Country:US
Mailing Address - Phone:817-545-7855
Mailing Address - Fax:
Practice Address - Street 1:3308 WENDOVER CT
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021
Practice Address - Country:US
Practice Address - Phone:817-545-7855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT00727133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX610242Medicare UPIN