Provider Demographics
NPI:1578399812
Name:FOGLE, BRITTANY
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:FOGLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 NE LOOP 820
Mailing Address - Street 2:#229
Mailing Address - City:HALTOM CITY
Mailing Address - State:TX
Mailing Address - Zip Code:76117
Mailing Address - Country:US
Mailing Address - Phone:817-226-0111
Mailing Address - Fax:
Practice Address - Street 1:5500 NE LOOP 820
Practice Address - Street 2:#229
Practice Address - City:HALTOM CITY
Practice Address - State:TX
Practice Address - Zip Code:76117
Practice Address - Country:US
Practice Address - Phone:817-226-0111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education