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NPI Code Detail

MEDICARE: MRS. SCARLETT DIANE GOAD DIETITIAN

MEDICARE: MRS. SCARLETT DIANE GOAD DIETITIAN
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
1133V00000XRegistered Dietitian668AR

General Provider Information

NPI Number : 1497714976
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SCARLETT DIANE GOAD DIETITIAN
Provider Business Mailing Address
First Line : PO BOX 15831
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72231-5831
Country : US
Telephone Number : 501-249-3602
Fax Number :
Provider Business Practice Location Address
First Line : 2901 MONTOPOLIS DR
Second Line :
City : AUSTIN
State : TX
Zip : 78741-6411
Country : US
Telephone Number : 512-389-1010
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2006
Last Update Date : 08/14/2009

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