Provider Demographics
NPI:1891431847
Name:RICKETTS, HEATHER NICOLE (RD)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:NICOLE
Last Name:RICKETTS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:NICOLE
Other - Last Name:GARZA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD
Mailing Address - Street 1:1310 APPLEBY AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3720
Mailing Address - Country:US
Mailing Address - Phone:512-627-8398
Mailing Address - Fax:
Practice Address - Street 1:27905 COMMERCIAL PARK RD STE 240
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-6580
Practice Address - Country:US
Practice Address - Phone:713-955-2123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT81765133V00000X
1031833133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDT81765OtherTEXAS DEPARTMENT OF LICENSING AND REGISTRATION
1031833OtherCOMMISSION ON DIETETIC REGISTRATION