Provider Demographics
NPI:1740875392
Name:BLEVINS, PRISCILLA (MS RD LD)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:BLEVINS
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 1:276 SHEPHERDS CROOK
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-2541
Mailing Address - Country:US
Mailing Address - Phone:210-904-6957
Mailing Address - Fax:
Practice Address - Street 1:276 SHEPHERDS CROOK
Practice Address - Street 2:
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023-2541
Practice Address - Country:US
Practice Address - Phone:210-904-6957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT84286133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered