Provider Demographics
NPI:1912686437
Name:DUQUE, CRYSTAL MICHELLE (RDN)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:MICHELLE
Last Name:DUQUE
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:MICHELLE
Other - Last Name:DUQUE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDN
Mailing Address - Street 1:6124 W PARKER RD STE 234
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8124
Mailing Address - Country:US
Mailing Address - Phone:972-468-9999
Mailing Address - Fax:972-981-3600
Practice Address - Street 1:6124 W PARKER RD STE 230
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8124
Practice Address - Country:US
Practice Address - Phone:972-468-9999
Practice Address - Fax:972-981-3600
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT88281133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered