Active NPI
Tracy L Bruen, MS, RD, LDN
- Registered Dietitian
- Lake Jackson, TX
National Provider Identifier
1609939636
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- DT80898
- Practice address
- 100 Medical Drive
Lake Jackson, TX 77566-5690 - Phone
- (979) 285-1602
- Fax
- (979) 299-2816
- NPI assigned
- Dec 19, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | DT80898 | TX | Primary |
Addresses
Primary practice location
100 Medical Drive
Lake Jackson, TX 77566-5690
Mailing address
100 Medical Drive
Lake Jackson, TX 77566-5690
Phone (979) 285-1602
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DT80898 | Other | TX | TEXAS STATE BOARD OF EXAMINERS OF DIETITIANS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DT80898 | TX | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Maury Regional Hospital | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinic/Center
- Hohenwald, TN
- NPI 1023038122
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166486400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1229040000000",
"number": "1609939636",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 MEDICAL DRIVE",
"city": "LAKE JACKSON",
"state": "TX",
"postal_code": "775665690",
"telephone_number": "979-285-1602",
"fax_number": "979-299-2816"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 MEDICAL DRIVE",
"city": "LAKE JACKSON",
"state": "TX",
"postal_code": "775665690",
"telephone_number": "979-285-1602",
"fax_number": "979-299-2816"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRUEN",
"first_name": "TRACY",
"middle_name": "L",
"name_prefix": "Ms.",
"credential": "MS, RD, LDN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-19",
"last_updated": "2008-12-12",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "TX",
"license": "DT80898",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TEXAS STATE BOARD OF EXAMINERS OF DIETITIANS",
"identifier": "DT80898",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lake Jackson, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.