Provider Demographics
NPI:1538395934
Name:GAINES, TERESA (RD,LD)
Entity type:Individual
Prefix:MISS
First Name:TERESA
Middle Name:
Last Name:GAINES
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:MISS
Other - First Name:TERESA
Other - Middle Name:
Other - Last Name:GAINES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD, LD
Mailing Address - Street 1:3219 SABRINA LN
Mailing Address - Street 2:
Mailing Address - City:COPPERAS COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522-3715
Mailing Address - Country:US
Mailing Address - Phone:254-289-0760
Mailing Address - Fax:
Practice Address - Street 1:1 JARRETT WHITE RD
Practice Address - Street 2:
Practice Address - City:TRIPLER ARMY MEDICAL CENTER
Practice Address - State:HI
Practice Address - Zip Code:96859-5001
Practice Address - Country:US
Practice Address - Phone:808-433-2387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-31
Last Update Date:2009-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT80776133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered