Provider Demographics
NPI:1003240029
Name:SHOWERS, CARISSA (RD)
Entity Type:Individual
Prefix:MRS
First Name:CARISSA
Middle Name:
Last Name:SHOWERS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:554 HAW BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:RICHLANDS
Mailing Address - State:NC
Mailing Address - Zip Code:28574-7228
Mailing Address - Country:US
Mailing Address - Phone:440-670-8383
Mailing Address - Fax:
Practice Address - Street 1:1425 S GLENBURNIE RD
Practice Address - Street 2:STE 7
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2626
Practice Address - Country:US
Practice Address - Phone:252-631-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-27
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1039861133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered