Provider Demographics
NPI:1548854607
Name:BEAVER, BRITTANY GALLES (MS, RD, LD)
Entity type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:GALLES
Last Name:BEAVER
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6615 CRAIGWAY RD
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77389-5250
Mailing Address - Country:US
Mailing Address - Phone:903-407-6501
Mailing Address - Fax:
Practice Address - Street 1:6615 CRAIGWAY RD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77389-5250
Practice Address - Country:US
Practice Address - Phone:903-407-6501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT82668133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDT82668OtherTEXAS DEPARTMENT OF LICENSING & REGULATION - LICENSED DIETITIAN