MEDICARE: CARRIE J REYNOLDS RD

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	133VN1006X	Metabolic Nutrition Registered Dietitian	DT07593	TX

General Provider Information

NPI Number	:	1487896437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE J REYNOLDS RD

Provider Business Mailing Address
First Line	:	1140 CYPRESS STATION DR
Second Line	:	SUITE 200
City	:	HOUSTON
State	:	TX
Zip	:	77090-3045
Country	:	US
Telephone Number	:	281-440-5300
Fax Number	:	832-232-5591

Provider Business Practice Location Address
First Line	:	1140 CYPRESS STATION DR
Second Line	:	SUITE 200
City	:	HOUSTON
State	:	TX
Zip	:	77090-3045
Country	:	US
Telephone Number	:	281-440-5300
Fax Number	:	832-232-5591

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

Provider Enumeration Date	:	04/06/2009
Last Update Date	:	11/12/2014

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