Provider Demographics
NPI:1649458480
Name:BESS, SUE ANN (RD, LD, CDE)
Entity type:Individual
Prefix:MS
First Name:SUE
Middle Name:ANN
Last Name:BESS
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 1:3500 W WHEATLAND RD
Mailing Address - Street 2:OUTPATIENT CENTER, SECOND FLOOR
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-3460
Mailing Address - Country:US
Mailing Address - Phone:214-947-7262
Mailing Address - Fax:214-947-7266
Practice Address - Street 1:3500 W WHEATLAND RD
Practice Address - Street 2:OUTPATIENT CENTER, SECOND FLOOR
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3460
Practice Address - Country:US
Practice Address - Phone:214-947-7262
Practice Address - Fax:214-947-7266
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT05829133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDT05829OtherSUE ANN BESS
TXDT05829OtherSUE ANN BESS