Jean A. Sullivan, RDN, LD
Individual provider Active NPI Registered Dietitian · Bowie, TX
NPI 1033428974 · NPPES record last updated Aug 3, 2022
Key facts
- NPI
- 1033428974
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Dietitian 133V00000X
- License
- DT05882 (TX)
- Practice address
- 1540 Rhodes LN
Bowie, TX 76230-7730 - Phone
- (469) 307-2426
- Fax
- (469) 420-5044
- NPI assigned
- Sep 27, 2010
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nourish, Inc. | Dietitian, Registered | Past | Accepting new patients |
| Metrocrest Orthopaedics & Sports Medicine | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | DT05882 | TX | Yes |
Addresses
Primary practice location
1540 Rhodes LN
Bowie, TX 76230-7730
Mailing address
1540 Rhodes LN
Bowie, TX 76230-7730
Phone (469) 307-2426
Other providers in Bowie, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 3, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.