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General NPI Number Information
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NPI Number | 1831046978
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Entity Type | Individual
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Provider Name | CASEY CARLGREN RD
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Gender | Male
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Dates
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Enumeration Date | 03/16/2026
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Last Update Date | 03/16/2026
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Provider Practice Location Address
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Address Line | 6680 COUNTY ROAD 319
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City | ALVARADO
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State | TX
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Zip | 76009-8499
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Country | US
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Telephone | 785-342-8345
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Fax |
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Provider Business Mailing Address
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Address Line | 6680 COUNTY ROAD 319
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City | ALVARADO
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State | TX
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Zip | 76009-8499
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Country | US
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Telephone | 785-342-8345
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1501X
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Taxonomy Name | Sports Dietetics Nutrition Registered Dietitian
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License Number | DT90497
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License Number State | TX
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