Provider Demographics
NPI:1598330540
Name:BASSINGER, CORAL (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:CORAL
Middle Name:
Last Name:BASSINGER
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:CORAL
Other - Middle Name:LYN
Other - Last Name:BUNCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 ORION STAR CT
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77382-4701
Mailing Address - Country:US
Mailing Address - Phone:903-363-7498
Mailing Address - Fax:
Practice Address - Street 1:10 ORION STAR CT
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77382-4701
Practice Address - Country:US
Practice Address - Phone:903-363-7498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT86721133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered