Healthcare Provider Details

I. General information

NPI: 1972738037
Provider Name (Legal Business Name): KARA MITCHELL MS,RD/LDN,ACSM-RCEP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 05/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3475 ERWIN RD
DURHAM NC
27710-0001
US

IV. Provider business mailing address

4400 TETBURY PL
RALEIGH NC
27613-4059
US

V. Phone/Fax

Practice location:
  • Phone: 919-660-6818
  • Fax:
Mailing address:
  • Phone: 919-660-6818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL002279
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: