Provider Demographics
NPI:1063052066
Name:TOPHAM, BRENNA
Entity type:Individual
Prefix:
First Name:BRENNA
Middle Name:
Last Name:TOPHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21331 PARK BEND DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-4701
Mailing Address - Country:US
Mailing Address - Phone:281-626-8260
Mailing Address - Fax:
Practice Address - Street 1:24285 KATY FWY STE 300
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-1128
Practice Address - Country:US
Practice Address - Phone:281-626-8260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-08
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT86334133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic