Provider Demographics
NPI:1013057306
Name:HARRELL, JOYCE MICHELLE (RD, LD, CDE)
Entity Type:Individual
Prefix:MS
First Name:JOYCE
Middle Name:MICHELLE
Last Name:HARRELL
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 SIMPSON DR
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-4031
Mailing Address - Country:US
Mailing Address - Phone:817-991-1805
Mailing Address - Fax:817-571-5162
Practice Address - Street 1:251 WESTPARK WAY
Practice Address - Street 2:SUITE 300
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-3742
Practice Address - Country:US
Practice Address - Phone:817-868-6410
Practice Address - Fax:817-571-5162
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2014-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT04560133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D8431Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
TXP87899Medicare UPIN