MEDICARE: MS. VIRGINIA IVES RD, LD, CDE, LPC

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	DT02650	TX
2	101YP2500X	Professional Counselor	60632	TX
3	133VN1006X	Metabolic Nutrition Registered Dietitian	DT02650	TX
4	207V00000X	Obstetrics & Gynecology Physician	DT02650	TX

General Provider Information

NPI Number	:	1346461365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VIRGINIA IVES RD, LD, CDE, LPC

Provider Business Mailing Address
First Line	:	3144 TEX BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-4224
Country	:	US
Telephone Number	:	214-538-6565
Fax Number	:

Provider Business Practice Location Address
First Line	:	3144 TEX BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-4224
Country	:	US
Telephone Number	:	214-538-6565
Fax Number	:

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

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	12/27/2024

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