MEDICARE: CALLEIGH HOPE REARDON RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	086093792	TX

General Provider Information

NPI Number	:	1356272983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CALLEIGH HOPE REARDON RD

Provider Business Mailing Address
First Line	:	1907 FLETCHER ST UNIT A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77009-8313
Country	:	US
Telephone Number	:	919-428-0971
Fax Number	:

Provider Business Practice Location Address
First Line	:	1907 FLETCHER ST UNIT A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77009-8313
Country	:	US
Telephone Number	:	919-428-0971
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2026
Last Update Date	:	05/25/2026

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