Individual
RAYNA LANE WOOTEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RD, LD
Contact information
Practice address
2200 BERGQUIST DR STE 1, LACKLAND AFB, TX 78236-9908
(210) 240-0230
Mailing address
8415 DRAGON ST, SAN ANTONIO, TX 78254-2420
(210) 240-0230
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DT07347
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DT07347
LICENSE NUMBER
TX
Enumeration date
05/21/2008
Last updated
12/29/2009
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