MEDICARE: SIMPLYNUTRITION

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1922241405	OTHER	TX	NPI

General Provider Information

NPI Number	:	1730761214
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIMPLYNUTRITION

Provider Business Mailing Address
First Line	:	1860 WHITE OAK DR APT 241
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77009-7556
Country	:	US
Telephone Number	:	832-834-6411
Fax Number	:

Provider Business Practice Location Address
First Line	:	1860 WHITE OAK DR
Second Line	:	241
City	:	HOUSTON
State	:	TX
Zip	:	77009-7556
Country	:	US
Telephone Number	:	832-834-6411
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED DIETITIAN
Name	:	ISABEL FELDMAN
Credential	:	RD
Telephone Number	:	832-834-6411

Provider Enumeration Date	:	04/24/2021
Last Update Date	:	04/24/2021

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