Provider Demographics
NPI:1831717495
Name:SPEARS, PHILLIP SKOT (RD, RDN)
Entity type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:SKOT
Last Name:SPEARS
Suffix:
Gender:M
Credentials:RD, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 KARLA DR
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-3937
Mailing Address - Country:US
Mailing Address - Phone:817-908-9015
Mailing Address - Fax:
Practice Address - Street 1:1421 KARLA DR
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-3937
Practice Address - Country:US
Practice Address - Phone:817-908-9015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT86546133V00000X
TX86104706133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered