Provider Demographics
NPI:1972035970
Name:BAKER, BRIANA GATTIS (MS, RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:BRIANA
Middle Name:GATTIS
Last Name:BAKER
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 BOB WHITE DR
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75154-4633
Mailing Address - Country:US
Mailing Address - Phone:409-782-9641
Mailing Address - Fax:
Practice Address - Street 1:220 BOB WHITE DR
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:TX
Practice Address - Zip Code:75154-4633
Practice Address - Country:US
Practice Address - Phone:409-782-9641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT84748133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered