Healthcare Provider Details

I. General information

NPI: 1598387870
Provider Name (Legal Business Name): NINA CARR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2020
Last Update Date: 11/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5835 CALLAGHAN RD STE 205
SAN ANTONIO TX
78228-1224
US

IV. Provider business mailing address

5835 CALLAGHAN RD STE 205
SAN ANTONIO TX
78228-1224
US

V. Phone/Fax

Practice location:
  • Phone: 210-519-6039
  • Fax:
Mailing address:
  • Phone: 210-519-6039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: