Provider Demographics
NPI:1821814534
Name:BRADY, BETHANY JOY (RD)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:JOY
Last Name:BRADY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 N 19TH ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-2400
Mailing Address - Country:US
Mailing Address - Phone:325-670-5970
Mailing Address - Fax:
Practice Address - Street 1:820 N 19TH ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2400
Practice Address - Country:US
Practice Address - Phone:325-670-5939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-26
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT83909133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered