Provider Demographics
NPI:1720839376
Name:GILLESPIE, BRIANNA NICHOLE (RDN)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:NICHOLE
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2834 SILO TURN
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-6092
Mailing Address - Country:US
Mailing Address - Phone:408-314-3854
Mailing Address - Fax:
Practice Address - Street 1:2834 SILO TURN
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-6092
Practice Address - Country:US
Practice Address - Phone:408-314-3854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT89218133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered