Provider Demographics
NPI:1295303949
Name:PATTERSON, VANESSA D (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:D
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9112 FLYING EAGLE LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76131-1748
Mailing Address - Country:US
Mailing Address - Phone:271-274-7291
Mailing Address - Fax:
Practice Address - Street 1:7609 PRESTON RD STE P2600
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3415
Practice Address - Country:US
Practice Address - Phone:469-497-2505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1017161133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered