Provider Demographics
NPI:1700253937
Name:RIDDLE, MARKA ANN (RD LD)
Entity Type:Individual
Prefix:MRS
First Name:MARKA
Middle Name:ANN
Last Name:RIDDLE
Suffix:
Gender:F
Credentials: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:PO BOX 6303
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79608-6303
Mailing Address - Country:US
Mailing Address - Phone:325-668-1670
Mailing Address - Fax:
Practice Address - Street 1:2582 IBERIS RD
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-6614
Practice Address - Country:US
Practice Address - Phone:325-668-1670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDTO7448133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered