Healthcare Provider Details

I. General information

NPI: 1336305192
Provider Name (Legal Business Name): RHONDA KIKER CARR RD, LD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2008
Last Update Date: 07/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 W ILLINOIS AVE
MIDLAND TX
79701-6407
US

IV. Provider business mailing address

4813 TIMBER LN
MIDLAND TX
79707-2832
US

V. Phone/Fax

Practice location:
  • Phone: 432-685-1111
  • Fax: 432-685-1239
Mailing address:
  • Phone: 432-520-8160
  • Fax: 432-685-1239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT05107
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: