Provider Demographics
NPI:1154912749
Name:BREAUX, MIYANNA (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:MIYANNA
Middle Name:
Last Name:BREAUX
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:MIYANNA
Other - Middle Name:
Other - Last Name:KIRKSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20719 FOX HOUND LN
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-1461
Mailing Address - Country:US
Mailing Address - Phone:832-656-0813
Mailing Address - Fax:
Practice Address - Street 1:20719 FOX HOUND LN
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-1461
Practice Address - Country:US
Practice Address - Phone:832-656-0813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-27
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86147446133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered