Provider Demographics
NPI:1942957832
Name:BOURGEOIS, ALLISON NICOLE (RD)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:NICOLE
Last Name:BOURGEOIS
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 1:22426 CARRIAGE BUSH
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78261-4416
Mailing Address - Country:US
Mailing Address - Phone:713-416-8829
Mailing Address - Fax:
Practice Address - Street 1:22426 CARRIAGE BUSH
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78261-4416
Practice Address - Country:US
Practice Address - Phone:713-416-8829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86116452133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered