IndividualActive
Jequithia Sims, NDTR
NPI 1104629617 · Registered Dietetic Technician · Grand Prairie, TX
Provider details
- NPI number
- 1104629617
- Entity type
- Individual
- Primary specialty
- Registered Dietetic TechnicianDietary & Nutritional Service Providers
- Credential
- NDTR
- Sex
- Female
- Sole proprietor
- Yes
- License
- 86170507 (TX)
Practice location
2952 Trail Lake Dr
Grand Prairie, TX 75054-5570
Phone: (214) 687-7203
Mailing address
2952 Trail Lake Dr
Grand Prairie, TX 75054-5570
Registry dates
- Enumerated
- 2025-03-31
- Last updated
- 2025-03-31
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.