Provider Demographics
NPI:1821847534
Name:MOFFITT, BRYLEIGH (RD, LD)
Entity type:Individual
Prefix:
First Name:BRYLEIGH
Middle Name:
Last Name:MOFFITT
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 1:7621 COUNTRYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-6490
Mailing Address - Country:US
Mailing Address - Phone:806-420-1899
Mailing Address - Fax:
Practice Address - Street 1:1901 MEDI PARK DR STE 222
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2107
Practice Address - Country:US
Practice Address - Phone:806-670-5075
Practice Address - Fax:806-216-6707
Is Sole Proprietor?:No
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT90180133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered