Provider Demographics
NPI:1124717129
Name:MILLER, MELISSA R (RD, RDN, LD)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:R
Last Name:MILLER
Suffix:
Gender:F
Credentials:RD, RDN, LD
Other - Prefix:MRS
Other - First Name:MISSY
Other - Middle Name:R
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11128 SHEFFIELD DR
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:TX
Mailing Address - Zip Code:75409-7670
Mailing Address - Country:US
Mailing Address - Phone:214-578-9168
Mailing Address - Fax:
Practice Address - Street 1:11128 SHEFFIELD DR
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:TX
Practice Address - Zip Code:75409-7670
Practice Address - Country:US
Practice Address - Phone:214-578-9168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT86059133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered