MEDICARE: NINA CARR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	133N00000X	Nutritionist	TX
2	172V00000X	Community Health Worker	TX
3	174H00000X	Health Educator	TX
4	133NN1002X	Nutrition Education Nutritionist	TX

General Provider Information

NPI Number	:	1598387870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NINA CARR

Provider Business Mailing Address
First Line	:	5835 CALLAGHAN RD STE 205
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78228-1224
Country	:	US
Telephone Number	:	210-519-6039
Fax Number	:

Provider Business Practice Location Address
First Line	:	5835 CALLAGHAN RD STE 205
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78228-1224
Country	:	US
Telephone Number	:	210-519-6039
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2020
Last Update Date	:	11/03/2022

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Directions to “ NINA CARR ” Practice Location

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