Provider Demographics
NPI:1427795780
Name:COX, CHELSEA TENNILLE (RD, LD, CDCES)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:TENNILLE
Last Name:COX
Suffix:
Gender:F
Credentials:RD, LD, CDCES
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:TENNILLE
Other - Last Name:LYLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:705 E MARSHALL AVE STE 1002
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-5660
Mailing Address - Country:US
Mailing Address - Phone:903-759-7200
Mailing Address - Fax:
Practice Address - Street 1:705 E MARSHALL AVE STE 1002
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5660
Practice Address - Country:US
Practice Address - Phone:903-759-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT82377133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered