Provider Demographics
NPI:1710432323
Name:OGG, BRANDY JO (RD, LD)
Entity Type:Individual
Prefix:MS
First Name:BRANDY
Middle Name:JO
Last Name:OGG
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-8408
Mailing Address - Country:US
Mailing Address - Phone:713-301-5906
Mailing Address - Fax:
Practice Address - Street 1:21 EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356-8408
Practice Address - Country:US
Practice Address - Phone:713-301-5906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT82315133N00000X
TX00996652133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered