Tina Marie Wynn, RD, LD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

DT82469 Issued in TX

Practice address

2495 S Braeswood Blvd
Houston, TX 77030-4332

Phone

(830) 515-3583

NPI assigned

Nov 17, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1479340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479340800000",
    "number": "1760924047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1038 1/2 COLUMBIA ST",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770087056",
            "telephone_number": "830-515-3583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2495 S BRAESWOOD BLVD",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770304332",
            "telephone_number": "830-515-3583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYNN",
        "first_name": "TINA",
        "middle_name": "MARIE",
        "credential": "RD, LD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-17",
        "last_updated": "2016-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "TX",
            "license": "DT82469",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carolyn Wynn, LCSW, LMFT
• Devonda Chantal Wynn
• Kiiuristi Rasheedah Wynn
• Kyla Jones Wynn, NP
• Ryann Wynn, PA-C
• Wesly Woodson Wynn, LPC
• Wynne & Associates Counseling
• Gracia L Wynne Duncan I, MD
• David Matthew Wynne, M.D.
• Kamyne Earline Wynne

• Registered Dietitian in Houston, TX
• Providers in Houston, TX by specialty
• Registered Dietitian in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 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.

Verify at the official NPI Registry.