Provider Demographics
NPI:1770632028
Name:PATTON, BEVERLY DIANE (RD)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:DIANE
Last Name:PATTON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 TREELINE PARK APT 1514
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-1844
Mailing Address - Country:US
Mailing Address - Phone:210-822-9445
Mailing Address - Fax:
Practice Address - Street 1:2950 KOEHLER RD
Practice Address - Street 2:
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-7535
Practice Address - Country:US
Practice Address - Phone:210-822-9445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT03961133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered