Provider Demographics
NPI:1912002494
Name:HARRIS, ELISABETH (MS,RD,CSP,LD,CNSC)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MS,RD,CSP,LD,CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 SAN JACINTO DR
Mailing Address - Street 2:APT #1114
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-8221
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1935 MOTOR ST
Practice Address - Street 2:CLINICAL NUTRITION
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7701
Practice Address - Country:US
Practice Address - Phone:214-456-7998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06970133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX925826OtherCDR - REGISTERED DIETITIA