Healthcare Provider Details

I. General information

NPI: 1508406232
Provider Name (Legal Business Name): LINDSEY MENGE MS, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2020
Last Update Date: 01/10/2020
Certification Date: 01/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4130 SPICEWOOD SPRINGS RD STE 100
AUSTIN TX
78759-8657
US

IV. Provider business mailing address

7602 WHISPERING OAKS DR
AUSTIN TX
78745-5935
US

V. Phone/Fax

Practice location:
  • Phone: 512-565-0671
  • Fax:
Mailing address:
  • Phone: 512-565-0671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberDT86112
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code133VN1301X
TaxonomyOncology Nutrition Registered Dietitian
License NumberDT86112
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT86112
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: