Provider Demographics
NPI:1457736183
Name:REZENTES, ALLISON BLAIR (MS, RD/LD)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:BLAIR
Last Name:REZENTES
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 1:1735 CIRCLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-4961
Mailing Address - Country:US
Mailing Address - Phone:940-595-6154
Mailing Address - Fax:
Practice Address - Street 1:5204 COLLEYVILLE BLVD
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-5829
Practice Address - Country:US
Practice Address - Phone:817-581-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT82976133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered