Provider Demographics
NPI:1043633068
Name:PRYOR, KARIN M (RDN)
Entity Type:Individual
Prefix:MRS
First Name:KARIN
Middle Name:M
Last Name:PRYOR
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:MISS
Other - First Name:KARIN
Other - Middle Name:M
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:4904 S POWER RD
Mailing Address - Street 2:SUITE # 103-188
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-3609
Mailing Address - Country:US
Mailing Address - Phone:602-770-7611
Mailing Address - Fax:480-505-3077
Practice Address - Street 1:2470 S VAL VISTA DR
Practice Address - Street 2:SUITE #104
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-1693
Practice Address - Country:US
Practice Address - Phone:602-770-7611
Practice Address - Fax:480-505-3077
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-27
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
930887133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered