Healthcare Provider Details

I. General information

NPI: 1245823079
Provider Name (Legal Business Name): KARA DAVIS RD, CSG, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2021
Last Update Date: 02/12/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2231 BUTLER ST
DALLAS TX
75235-7826
US

IV. Provider business mailing address

5433 PERCY PRIEST ST
FORT WORTH TX
76179-1480
US

V. Phone/Fax

Practice location:
  • Phone: 214-590-5224
  • Fax:
Mailing address:
  • Phone: 817-291-7520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1101X
TaxonomyGerontological Nutrition Registered Dietitian
License NumberDT06401
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT06401
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: