Provider Demographics
NPI:1891859450
Name:FIVECOAT, GRETCHEN ANN (RD)
Entity Type:Individual
Prefix:MS
First Name:GRETCHEN
Middle Name:ANN
Last Name:FIVECOAT
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MS
Other - First Name:GRETCHEN
Other - Middle Name:ANN
Other - Last Name:REINHARDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1100 WILFORD HALL LOOP BLDG 4554
Mailing Address - Street 2:
Mailing Address - City:JBSA LACKLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78236-5638
Mailing Address - Country:US
Mailing Address - Phone:210-292-6226
Mailing Address - Fax:
Practice Address - Street 1:1100 WILFORD HALL LOOP RM 3G053
Practice Address - Street 2:
Practice Address - City:JBSA LACKLAND
Practice Address - State:TX
Practice Address - Zip Code:78236-5638
Practice Address - Country:US
Practice Address - Phone:210-292-5023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
887919133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered