Provider Demographics
NPI:1427721877
Name:BEARD, TAYLOR BRADLEY (RDN, LD)
Entity type:Individual
Prefix:MS
First Name:TAYLOR
Middle Name:BRADLEY
Last Name:BEARD
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 S NEW RD APT 5203
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76706-3799
Mailing Address - Country:US
Mailing Address - Phone:417-827-8064
Mailing Address - Fax:
Practice Address - Street 1:3511 SHORE SHADOWS DR
Practice Address - Street 2:
Practice Address - City:CROSBY
Practice Address - State:TX
Practice Address - Zip Code:77532-7221
Practice Address - Country:US
Practice Address - Phone:713-588-6222
Practice Address - Fax:185-573-2137
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT85770133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered