Individual
MARY KATHERINE CHAUNCEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, LD, CDE
Contact information
Practice address
3601 4TH ST, SUITE 4B341, LUBBOCK, TX 79430-0002
(806) 743-2757
(806) 743-2563
Mailing address
PO BOX 5865, LUBBOCK, TX 79408-5865
(806) 743-2898
(806) 743-2787
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DT04210
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8G6679
MEDICARE
TX
Enumeration date
07/15/2006
Last updated
05/03/2016
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