Provider Demographics
NPI:1033360912
Name:ECKARD, CARLY S (MS, RD, CNSC)
Entity Type:Individual
Prefix:MRS
First Name:CARLY
Middle Name:S
Last Name:ECKARD
Suffix:
Gender:F
Credentials:MS, RD, CNSC
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:S
Other - Last Name:HAYWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:CMR 427 BOX 2651
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09630-0027
Mailing Address - Country:US
Mailing Address - Phone:388-736-6020
Mailing Address - Fax:
Practice Address - Street 1:CMR 427 BOX 2651
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09630-0027
Practice Address - Country:US
Practice Address - Phone:388-736-6020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-09
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT81452133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered