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NPI Code Detail

MEDICARE: DOHERTY NUTRITION LLC

MEDICARE: DOHERTY NUTRITION LLC
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 Dietitian

General Provider Information

NPI Number : 1326502832
Entity Type Code : Organization
Provider Name (Legal Business Name) : DOHERTY NUTRITION LLC
Provider Business Mailing Address
First Line : 17060 DALLAS PKWY STE 112
Second Line :
City : DALLAS
State : TX
Zip : 75248-1905
Country : US
Telephone Number : 469-372-2022
Fax Number : 833-290-5413
Provider Business Practice Location Address
First Line : 17060 DALLAS PKWY STE 112
Second Line :
City : DALLAS
State : TX
Zip : 75248-1905
Country : US
Telephone Number : 469-372-2022
Fax Number : 833-290-5413
Authorized Official
Title or Position : OPERATIONS MANAGER
Name : KRISTA WYATT
Credential :
Telephone Number : 469-372-2022
Provider Enumeration Date : 01/29/2019
Last Update Date : 03/07/2024

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Directions to “DOHERTY NUTRITION LLC ” Practice Location

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