Provider Demographics
NPI:1972313302
Name:WILLIS, SHARRON (RDN LDN)
Entity type:Individual
Prefix:
First Name:SHARRON
Middle Name:
Last Name:WILLIS
Suffix:
Gender:F
Credentials:RDN LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6114 WINDWOOD ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71107-9614
Mailing Address - Country:US
Mailing Address - Phone:832-322-3082
Mailing Address - Fax:
Practice Address - Street 1:2330 S LAMAR BLVD STE 300
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-5265
Practice Address - Country:US
Practice Address - Phone:512-593-1593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT80891133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered