Healthcare Provider Details

I. General information

NPI: 1699310821
Provider Name (Legal Business Name): CARLIE ASTON BRIGGS DTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2019
Last Update Date: 11/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 WILSON HTS
KALISPELL MT
59901-7468
US

IV. Provider business mailing address

4022 E. GREENWAY RD. STE 11 #175
PHOENIX AZ
85032
US

V. Phone/Fax

Practice location:
  • Phone: 319-429-5978
  • Fax:
Mailing address:
  • Phone: 319-429-5978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code136A00000X
TaxonomyRegistered Dietetic Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: