Provider Demographics
NPI:1205239407
Name:MEACHUM, PAGE BAILEY (RD, CSP, LD)
Entity type:Individual
Prefix:MRS
First Name:PAGE
Middle Name:BAILEY
Last Name:MEACHUM
Suffix:
Gender:F
Credentials:RD, CSP, LD
Other - Prefix:
Other - First Name:PAGE
Other - Middle Name:CARRERE
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6651 AINTREE CIR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-1622
Mailing Address - Country:US
Mailing Address - Phone:504-231-9648
Mailing Address - Fax:
Practice Address - Street 1:1935 MEDICAL DISTRICT DR
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:214-456-2133
Practice Address - Fax:214-456-6287
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT83443133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric