Provider Demographics
NPI:1831087055
Name:WILSON, SIMONE (RDN)
Entity type:Individual
Prefix:
First Name:SIMONE
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 SPRING GREEN BLVD STE 120
Mailing Address - Street 2:#1058
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-7463
Mailing Address - Country:US
Mailing Address - Phone:713-566-1999
Mailing Address - Fax:
Practice Address - Street 1:1708 SPRING GREEN BLVD STE 120
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-7463
Practice Address - Country:US
Practice Address - Phone:713-566-1999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-26
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered