Provider Demographics
NPI:1184123523
Name:HARRIS, NICOLE ALLENIA (MS, RDN, LD, IFNCP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ALLENIA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MS, RDN, LD, IFNCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3323 SCENIC LN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-3454
Mailing Address - Country:US
Mailing Address - Phone:102-708-8931
Mailing Address - Fax:
Practice Address - Street 1:1870 W BITTERS RD STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248-1827
Practice Address - Country:US
Practice Address - Phone:210-545-4422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-11
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86074091133V00000X
TXDT84838133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered