Provider Demographics
NPI:1265769053
Name:MILLISON, BEVERLY (RD/LD CDE)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:MILLISON
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 1:3701 LAVORTON PL
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-6708
Mailing Address - Country:US
Mailing Address - Phone:972-724-1885
Mailing Address - Fax:203-547-6492
Practice Address - Street 1:3701 LAVORTON PL
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-6708
Practice Address - Country:US
Practice Address - Phone:972-724-1885
Practice Address - Fax:203-547-6492
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-16
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT04373133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic