Active NPI
Marie Collins Custead
- Registered Dietitian
- Nacogdoches, TX
National Provider Identifier
1730638164
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- DT84467
- Practice address
- Sfa Athletic Fieldhouse 712 Hayter St
Nacogdoches, TX 75962-0001 - Phone
- (936) 468-3506
- Fax
- (936) 468-4052
- NPI assigned
- Sep 27, 2016
- Sex
- Female
- Sole proprietor
- No
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 | DT84467 | TX | Primary |
Addresses
Primary practice location
Sfa Athletic Fieldhouse 712 Hayter St
Nacogdoches, TX 75962-0001
Mailing address
Sfa Athletic Fieldhouse 712 Hayter St
Nacogdoches, TX 75962-0001
Phone (936) 468-3506
Other names 1
- Marie Collins Custead
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DT84467 | TX | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1474934400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1474934400000",
"number": "1730638164",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "SFA ATHLETIC FIELDHOUSE 712 HAYTER ST",
"city": "NACOGDOCHES",
"state": "TX",
"postal_code": "759620001",
"telephone_number": "936-468-3506",
"fax_number": "936-468-4052"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "SFA ATHLETIC FIELDHOUSE 712 HAYTER ST",
"city": "NACOGDOCHES",
"state": "TX",
"postal_code": "759620001",
"telephone_number": "936-468-3506",
"fax_number": "936-468-4052"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CUSTEAD",
"first_name": "MARIE",
"middle_name": "COLLINS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-09-27",
"last_updated": "2016-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "TX",
"license": "DT84467",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "MARIE",
"last_name": "CUSTEAD",
"middle_name": "COLLINS",
"credential": "RD., LD",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Nacogdoches, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.