Individual
LESLIE BRACKEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD/LD
Contact information
Practice address
3840 HULEN ST, HTN, CLIENT ACCOUNTING, FORT WORTH, TX 76107-7277
(817) 569-4396
Mailing address
PO BOX 2603, HTN, CLIENT ACCOUNTING, FORT WORTH, TX 76113-2603
(817) 569-4396
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DT06772
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
211341701
—
TX
01
—
8CK053
BCBS
TX
Enumeration date
06/02/2010
Last updated
12/06/2011
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