Provider Demographics
NPI:1295235356
Name:MARTINSON, MEGHAN ELISE (MS, RD)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:ELISE
Last Name:MARTINSON
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 BAREBACK LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76131-3121
Mailing Address - Country:US
Mailing Address - Phone:817-915-7635
Mailing Address - Fax:
Practice Address - Street 1:653 BAREBACK LN
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76131-3121
Practice Address - Country:US
Practice Address - Phone:817-915-7635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT82015133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered