Provider Demographics
NPI:1861896441
Name:PREVENTATIVE NUTRITION SPECIALISTS
Entity type:Organization
Organization Name:PREVENTATIVE NUTRITION SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSIANNA
Authorized Official - Middle Name:R
Authorized Official - Last Name:SAVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LD,
Authorized Official - Phone:979-353-1126
Mailing Address - Street 1:PO BOX 2238
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77806-2238
Mailing Address - Country:US
Mailing Address - Phone:979-353-1126
Mailing Address - Fax:979-530-9551
Practice Address - Street 1:2110 E VILLA MARIA RD
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2542
Practice Address - Country:US
Practice Address - Phone:979-353-1126
Practice Address - Fax:979-530-9551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-10
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, RenalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX386179Medicare UPIN