Healthcare Provider Details

I. General information

NPI: 1346165370
Provider Name (Legal Business Name): CARLY TEMPLETON RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 HIGHLAND BLVD STE 2160
BOZEMAN MT
59715-6913
US

IV. Provider business mailing address

935 HIGHLAND BLVD STE 2160
BOZEMAN MT
59715-6913
US

V. Phone/Fax

Practice location:
  • Phone: 406-414-5331
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberMED-NUTR-LIC-175062
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: