MARIE COLLINS CUSTEAD (NPI# 1730638164) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730638164 |
| Entity Type | Individual |
| Full Name | MARIE COLLINS CUSTEAD |
| Other Name | MARIE COLLINS CUSTEAD |
| Practice Address |
Sfa Athletic Fieldhouse 712 Hayter St Nacogdoches TX 75962-0001 |
| Practice Telephone | 9364683506 |
| Practice Fax Number | 9364684052 |
| Mailing Telephone | 9364683506 |
| Mailing Fax Number | 9364684052 |
| Enumeration Date | 2016-09-27 |
| Last Update Date | 2016-09-27 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 133V00000X | Dietitian, Registered | DT84467 | TX | Dietary & Nutritional Service Providers |
| Street Address |
SFA ATHLETIC FIELDHOUSE 712 HAYTER ST |
| City | NACOGDOCHES |
| State | TX |
| Zip Code | 75962-0001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073643300 | Linda Stark Bobo | Specialist/Technologist | 1936 N Street, Hpe Complex, Rm 204, Sfasfu, Nacogdoches, TX 75962 | 2007-03-06 |
| 1346895620 | Daniel Anthony Latourelle | Specialist/Technologist | 712 Hayter Street, Nacogdoches, TX 75962-0001 | 2019-08-05 |
| 1275081051 | Kira Rubin | Specialist/Technologist | Sfa Athletic Fieldhouse, 712 Hayter St, Nacogdoches, TX 75962-0001 | 2016-09-21 |
| 1790113736 | Jennifer Boynton | Dietitian, Registered | 712 Hayter 13010 Sfa Sta, Nacogdoches, TX 75962-0001 | 2013-10-30 |
| 1114361250 | Stephen F. Austin State University | Clinic/Center | 2106 Raquet St, Nacogdoches, TX 75962-0001 | 2013-04-19 |
| 1336411818 | Alberta Nichols | Specialist/Technologist | 113 Hayter St, Nacogdoches, TX 75962-0001 | 2012-01-31 |
| 1881719821 | Raymond Lynn Eastman | Psychologist | 209 Blount St, Nacogdoches, TX 75962-0001 | 2007-03-20 |
| 1225185531 | John Miller | Family Medicine | 13058-sfa Statiion, Nacogdoches, TX 75962-0001 | 2007-01-05 |
| 1093876005 | Renal Care Group Nacogdoches, LLP | Clinic/Center | 3226 University Dr, 100, Nacogdoches, TX 75962-0001 | 2006-12-13 |
| 1265501076 | Stephen F. Austin State Univ. Health Service | Clinic/Center | 2106 Raguet St N, Box 13058, Nacogdoches, TX 75962-0001 | 2006-11-07 |
| Find all providers in zip 75962 | ||||
| Taxonomy Code | 133V00000X |
| Grouping | Dietary & Nutritional Service Providers |
| Classification | Dietitian, Registered |
| A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor’s degree at a US regionally accredited university or college and course work approved by The American Dietetic Association (ADA); an ADA-accredited or approved, supervised practice program, typically 6 to 12 months in length; a national examination administered by the Commission on Dietetic Registration; and continuing professional educational requirements to maintain registration. |
| Notes: Source: The American Dietetic Association. Becoming a Registered Dietitian – a food and nutrition expert. Chicago, IL: The American Dietetic Association, July 1997. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770147852 | Sarah Elizabeth Bullard | Dietitian, Registered | 409 E Lakewood St, Nacogdoches, TX 75965-2531 | 2019-04-24 |
| 1184025694 | Timothy Scallon | Dietitian, Registered | 231 County Road 2322, Nacogdoches, TX 75961-8823 | 2014-09-16 |
| 1790113736 | Jennifer Boynton | Dietitian, Registered | 712 Hayter 13010 Sfa Sta, Nacogdoches, TX 75962-0001 | 2013-10-30 |
| 1710296009 | Lisa Kennedy | Dietitian, Registered | 4635 Ne Stallings Dr Ste 104, Nacogdoches, TX 75965 | 2010-10-04 |
| 1235446998 | Caroline Sullivan | Dietitian, Registered | 3622 Colony Creek Dr, Nacogdoches, TX 75965-6976 | 2010-09-01 |
| 1164579256 | Kathy C Conyer | Dietitian, Registered | 651 County Road 811, Nacogdoches, TX 75964-2711 | 2007-01-04 |
| 1699258608 | Hallie Bernard | Dietitian, Registered | 4920 Ne Stallings Dr, Nacogdoches, TX 75965-1254 | 2018-09-14 |
| 1861973091 | Lisa A Kennedy, Rd LLC | Dietitian, Registered | 4635 Ne Stallings Dr Ste 104, Nacogdoches, TX 75965-1667 | 2018-08-26 |
| 1346786258 | Hannah Dunahoe | Dietitian, Registered | 4920 Ne Stallings Dr, Nacogdoches, TX 75965-1254 | 2017-01-16 |
| 1629481932 | Jennifer Raegan Best | Dietitian, Registered | 4920 Ne Stallings Dr, Nacogdoches, TX 75965-1254 | 2014-06-04 |
| Find all providers in NACOGDOCHES | ||||
| City | NACOGDOCHES |
| Zip Code | 75962 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.