Provider Demographics
NPI:1316339344
Name:ALLEN, BRANDI LORENE (MS, RD, LD)
Entity type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:LORENE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4413 LAKE HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-8978
Mailing Address - Country:US
Mailing Address - Phone:469-360-7754
Mailing Address - Fax:
Practice Address - Street 1:1935 MEDICAL DISTRICT DR
Practice Address - Street 2:CLINICAL NUTRITION
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7701
Practice Address - Country:US
Practice Address - Phone:214-456-2178
Practice Address - Fax:214-456-6287
Is Sole Proprietor?:No
Enumeration Date:2015-02-27
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX#DT83314133VN1004X
TX01000691133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric