Healthcare Provider Details

I. General information

NPI: 1316339344
Provider Name (Legal Business Name): BRANDI LORENE ALLEN M.S., R.D., L.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2015
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 MEDICAL DISTRICT DR CLINICAL NUTRITION
DALLAS TX
75235-7701
US

IV. Provider business mailing address

4413 LAKE HAVEN DR
ROWLETT TX
75088-8978
US

V. Phone/Fax

Practice location:
  • Phone: 214-456-2178
  • Fax: 214-456-6287
Mailing address:
  • Phone: 469-360-7754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number#DT83314
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number01000691
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: