Healthcare Provider Details

I. General information

NPI: 1376412551
Provider Name (Legal Business Name): GERALD WAYNE DYSON HHP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: BEAUX DYSON HHP

II. Dates (important events)

Enumeration Date: 11/04/2025
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 ALANIS DR
WYLIE TX
75098-4179
US

IV. Provider business mailing address

409 WOODHOLLOW DR
WYLIE TX
75098-3854
US

V. Phone/Fax

Practice location:
  • Phone: 972-885-3517
  • Fax:
Mailing address:
  • Phone: 972-885-3517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: