MEDICARE: MRS. BRITTANY A CRUMP RD, LD

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	DT83650	TX

General Provider Information

NPI Number	:	1437774247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRITTANY A CRUMP RD, LD

Provider Business Mailing Address
First Line	:	319 SHARON DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-7440
Country	:	US
Telephone Number	:	214-263-5220
Fax Number	:

Provider Business Practice Location Address
First Line	:	2121 N PEARL ST STE 300
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75201-2494
Country	:	US
Telephone Number	:	281-948-8014
Fax Number	:

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

Provider Enumeration Date	:	06/08/2020
Last Update Date	:	06/08/2020

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