Provider Demographics
NPI:1255112108
Name:TRAHAN, JANET KELLEY (RD LD)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:KELLEY
Last Name:TRAHAN
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 1:713 6TH ST
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-2952
Mailing Address - Country:US
Mailing Address - Phone:832-621-7391
Mailing Address - Fax:
Practice Address - Street 1:713 6TH ST
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-2952
Practice Address - Country:US
Practice Address - Phone:832-621-7391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDTO5027133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist