Healthcare Provider Details

I. General information

NPI: 1043104730
Provider Name (Legal Business Name): TAHTIANA CALDWELL RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2025
Last Update Date: 06/06/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 SPICEWOOD SPRINGS RD STE 1022
AUSTIN TX
78759-8543
US

IV. Provider business mailing address

13635 RUTLEDGE SPUR APT 9303
AUSTIN TX
78717-0167
US

V. Phone/Fax

Practice location:
  • Phone: 512-257-0898
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT92219
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: