Healthcare Provider Details

I. General information

NPI: 1205326667
Provider Name (Legal Business Name): MICHAELA MASTERS CARRINGTON RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2018
Last Update Date: 05/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5303 HARRY HINES BLVD
DALLAS TX
75390-7208
US

IV. Provider business mailing address

5323 HARRY HINES BLVD
DALLAS TX
75390-7201
US

V. Phone/Fax

Practice location:
  • Phone: 214-645-8300
  • Fax:
Mailing address:
  • Phone: 214-645-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT85253
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: