Healthcare Provider Details

I. General information

NPI: 1982977591
Provider Name (Legal Business Name): K'LAYN BROWN RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2012
Last Update Date: 07/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 DECKER DR STE 100
IRVING TX
75062-4129
US

IV. Provider business mailing address

320 DECKER DR STE 100
IRVING TX
75062-4129
US

V. Phone/Fax

Practice location:
  • Phone: 888-320-1776
  • Fax:
Mailing address:
  • Phone: 832-237-3500
  • Fax: 281-897-9906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT82064
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: