Healthcare Provider Details

I. General information

NPI: 1154886349
Provider Name (Legal Business Name): ELIZABETH JOURNEY MS, RD, LD, CNSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2019
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 MEDICAL DISTRICT DR
DALLAS TX
75235-7701
US

IV. Provider business mailing address

819 SCOTTSDALE DR
RICHARDSON TX
75080-5904
US

V. Phone/Fax

Practice location:
  • Phone: 214-456-0854
  • Fax:
Mailing address:
  • Phone: 469-417-9811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT87299
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: