Healthcare Provider Details

I. General information

NPI: 1164794301
Provider Name (Legal Business Name): LEANNE SKINNER R.D.,L.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2012
Last Update Date: 02/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4127 HONEYCOMB ROCK CIRCLE
AUSTIN TX
78731
US

IV. Provider business mailing address

PO BOX 26660
AUSTIN TX
78755-0660
US

V. Phone/Fax

Practice location:
  • Phone: 512-345-2285
  • Fax: 512-345-2285
Mailing address:
  • Phone: 512-345-2285
  • Fax: 512-345-2285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberDT02354
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: