Provider Demographics
NPI:1639054034
Name:EVANS, BROOKE (MCN, RDN, LD)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:MCN, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 T C JESTER BLVD APT 490
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-3380
Mailing Address - Country:US
Mailing Address - Phone:210-452-8404
Mailing Address - Fax:
Practice Address - Street 1:7515 MAIN ST STE 400
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4553
Practice Address - Country:US
Practice Address - Phone:713-264-3731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT88976133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered