Provider Demographics
NPI:1033241443
Name:GUFFEY, KARLA RAE (MS, RD, LD, CDE)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:RAE
Last Name:GUFFEY
Suffix:
Gender:F
Credentials:MS, RD, LD, CDE
Other - Prefix:
Other - First Name:KARLA
Other - Middle Name:RAE
Other - Last Name:WALLACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:PO BOX 6971
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-0971
Mailing Address - Country:US
Mailing Address - Phone:903-931-2612
Mailing Address - Fax:
Practice Address - Street 1:2002 PUTMAN WAY
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-3943
Practice Address - Country:US
Practice Address - Phone:903-931-2612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT07327133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDT07327OtherTX DIETITIAN LICENSE
950570OtherCDR REGISTERED DIETITIAN