Provider Demographics
NPI:1831828698
Name:CUNNINGHAM, VANESSA BALKE (RDN)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:BALKE
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4390 FM 1600
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:TX
Mailing Address - Zip Code:76520-3574
Mailing Address - Country:US
Mailing Address - Phone:281-352-6090
Mailing Address - Fax:
Practice Address - Street 1:4390 FM 1600
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:TX
Practice Address - Zip Code:76520-3574
Practice Address - Country:US
Practice Address - Phone:281-352-6090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT84259133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered