Provider Demographics
NPI:1245469857
Name:MORAVEC, JODI (MS, RD,LD, CDE,BCADM)
Entity type:Individual
Prefix:MS
First Name:JODI
Middle Name:
Last Name:MORAVEC
Suffix:
Gender:F
Credentials:MS, RD,LD, CDE,BCADM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4241 KEYS DR
Mailing Address - Street 2:
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-3233
Mailing Address - Country:US
Mailing Address - Phone:940-367-3270
Mailing Address - Fax:
Practice Address - Street 1:1708 COIT RD
Practice Address - Street 2:SUITE 100
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-5024
Practice Address - Country:US
Practice Address - Phone:469-467-0400
Practice Address - Fax:469-467-7009
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-06
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT81202133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered