Provider Demographics
NPI:1821789645
Name:JANA PITCOCK, RD LLC
Entity Type:Organization
Organization Name:JANA PITCOCK, RD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:JANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PITCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:407-399-5324
Mailing Address - Street 1:1620 QUAIL CREEK LN
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-1941
Mailing Address - Country:US
Mailing Address - Phone:407-399-5324
Mailing Address - Fax:
Practice Address - Street 1:1620 QUAIL CREEK LN
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-1941
Practice Address - Country:US
Practice Address - Phone:407-399-5324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service