Provider Demographics
NPI:1700195013
Name:HOOPER, VANESSA Y (MS, RD/LD)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:Y
Last Name:HOOPER
Suffix:
Gender:F
Credentials:MS, RD/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 N MOUND ST
Mailing Address - Street 2:DIETARY DEPARTMENT
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75961-4027
Mailing Address - Country:US
Mailing Address - Phone:936-569-4106
Mailing Address - Fax:936-569-4647
Practice Address - Street 1:1204 N MOUND ST
Practice Address - Street 2:DIETARY DEPARTMENT
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-4027
Practice Address - Country:US
Practice Address - Phone:936-569-4106
Practice Address - Fax:936-569-4647
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT81062133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered