Healthcare Provider Details

I. General information

NPI: 1114121498
Provider Name (Legal Business Name): COURTNEY BELL ASSIR RD, LD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 HOSPITAL PKWY
BEDFORD TX
76022-6913
US

IV. Provider business mailing address

5425 EL CAMPO AVE
FORT WORTH TX
76107-4701
US

V. Phone/Fax

Practice location:
  • Phone: 817-685-4000
  • Fax:
Mailing address:
  • Phone: 817-737-9533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT06503
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: