Provider Demographics
NPI:1902850969
Name:WITTEN, MELISSA LEA (RD LD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LEA
Last Name:WITTEN
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:PO BOX 66308
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77266-6308
Mailing Address - Country:US
Mailing Address - Phone:713-830-3033
Mailing Address - Fax:713-830-3091
Practice Address - Street 1:3311 RICHMOND AVE
Practice Address - Street 2:100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-3018
Practice Address - Country:US
Practice Address - Phone:713-830-3033
Practice Address - Fax:713-830-3091
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06779133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A6275Medicare ID - Type Unspecified
TXP57709Medicare UPIN