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NPI Code Detail

MEDICARE: NICOLE ALLENIA HARRIS MS, RDN, LD, IFNCP

MEDICARE: NICOLE ALLENIA HARRIS MS, RDN, LD, IFNCP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian86074091TX
2133V00000XRegistered DietitianDT84838TX

General Provider Information

NPI Number : 1184123523
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE ALLENIA HARRIS MS, RDN, LD, IFNCP
Provider Business Mailing Address
First Line : 3323 SCENIC LN
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78230-3454
Country : US
Telephone Number : 102-708-8931
Fax Number :
Provider Business Practice Location Address
First Line : 1870 W BITTERS RD STE 101
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78248-1827
Country : US
Telephone Number : 210-545-4422
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/11/2018
Last Update Date : 08/14/2023

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