Provider Demographics
NPI:1447536222
Name:GLEATON, SUSAN KAY (RD)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:KAY
Last Name:GLEATON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:KAY
Other - Last Name:MICKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:355 COUNTY ROAD 212
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76240-1848
Mailing Address - Country:US
Mailing Address - Phone:940-736-1019
Mailing Address - Fax:940-612-4825
Practice Address - Street 1:355 COUNTY ROAD 212
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240-1848
Practice Address - Country:US
Practice Address - Phone:940-736-1019
Practice Address - Fax:940-612-4825
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX607418133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered