MEDICARE: MRS. KARA LEWIS RD, LD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	DT84882	TX

General Provider Information

NPI Number	:	1427607993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KARA LEWIS RD, LD

Provider Business Mailing Address
First Line	:	291 CAPRICCIO LN
Second Line	:
City	:	MONTGOMERY
State	:	TX
Zip	:	77316-1640
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	26410 OAK RIDGE DR
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77380-1965
Country	:	US
Telephone Number	:	386-569-3571
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2019
Last Update Date	:	09/08/2019

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