Provider Demographics
NPI:1003168501
Name:PRASIFKA, TRISTA E (RD, LD)
Entity type:Individual
Prefix:MRS
First Name:TRISTA
Middle Name:E
Last Name:PRASIFKA
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 1:119 MEADOW GLEN LN
Mailing Address - Street 2:
Mailing Address - City:OVILLA
Mailing Address - State:TX
Mailing Address - Zip Code:75154-1665
Mailing Address - Country:US
Mailing Address - Phone:214-597-1248
Mailing Address - Fax:
Practice Address - Street 1:119 MEADOW GLEN LN
Practice Address - Street 2:
Practice Address - City:OVILLA
Practice Address - State:TX
Practice Address - Zip Code:75154-1665
Practice Address - Country:US
Practice Address - Phone:214-597-1248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT81511133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered