Healthcare Provider Details

I. General information

NPI: 1750065785
Provider Name (Legal Business Name): COYE SUE HOTH RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 06/12/2023
Certification Date: 06/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15692 LAKEWAY DR
WILLIS TX
77318-3178
US

IV. Provider business mailing address

15692 LAKEWAY DR
WILLIS TX
77318-3178
US

V. Phone/Fax

Practice location:
  • Phone: 281-839-5458
  • Fax:
Mailing address:
  • Phone: 281-839-5458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT81411
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: