MEDICARE: ROCHELLE CROW RD

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
1	133V00000X	Registered Dietitian	DT84874	TX

General Provider Information

NPI Number	:	1295224665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROCHELLE CROW RD

Provider Business Mailing Address
First Line	:	1307 BAYLOR BLVD
Second Line	:
City	:	BIG SPRING
State	:	TX
Zip	:	79720-5230
Country	:	US
Telephone Number	:	806-470-0683
Fax Number	:

Provider Business Practice Location Address
First Line	:	1307 BAYLOR BLVD
Second Line	:
City	:	BIG SPRING
State	:	TX
Zip	:	79720-5230
Country	:	US
Telephone Number	:	806-470-0683
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2018
Last Update Date	:	05/12/2020

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