Healthcare Provider Details

I. General information

NPI: 1841960408
Provider Name (Legal Business Name): CHRIS CARNRIGHT RD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2021
Last Update Date: 09/15/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 WOODBERRY HILL DR
SOUTHINGTON CT
06489-1830
US

IV. Provider business mailing address

20 WOODBERRY HILL DR
SOUTHINGTON CT
06489-1830
US

V. Phone/Fax

Practice location:
  • Phone: 860-869-1095
  • Fax:
Mailing address:
  • Phone: 860-869-1095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License Number943
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: