Healthcare Provider Details

I. General information

NPI: 1669435921
Provider Name (Legal Business Name): ERIN THOMPSON RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIN CHAMBERS RD

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 11/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 E HOUSTON ST STE 550
TYLER TX
75702-8366
US

IV. Provider business mailing address

PO BOX 846098
DALLAS TX
75284-6098
US

V. Phone/Fax

Practice location:
  • Phone: 903-592-7393
  • Fax: 903-597-7538
Mailing address:
  • Phone: 903-324-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT06052
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: