Healthcare Provider Details

I. General information

NPI: 1174435473
Provider Name (Legal Business Name): CRYSTAL WHITTEN PHD, MS, RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 PLEASANT VIEW LN
OROVILLE CA
95966-8257
US

IV. Provider business mailing address

4804 TAMANACO CT
ARLINGTON TX
76017-2633
US

V. Phone/Fax

Practice location:
  • Phone: 817-879-4980
  • Fax:
Mailing address:
  • Phone: 817-879-4980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number17275
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: