Provider Demographics
NPI:1710322342
Name:SCOGGINS, CASSIDY MARIA (MS, RD, LD)
Entity Type:Individual
Prefix:MS
First Name:CASSIDY
Middle Name:MARIA
Last Name:SCOGGINS
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 1:2600 SAINT MICHAEL DR
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-5220
Mailing Address - Country:US
Mailing Address - Phone:903-614-7139
Mailing Address - Fax:903-614-5354
Practice Address - Street 1:2600 SAINT MICHAEL DR
Practice Address - Street 2:ARAMARK DIETITIANS SUITE 311
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-5220
Practice Address - Country:US
Practice Address - Phone:903-614-7139
Practice Address - Fax:903-614-5354
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-09
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT81972133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered