Provider Demographics
NPI:1073869194
Name:WALTERS, CARLA G (MS, RD, LD, CDE)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:G
Last Name:WALTERS
Suffix:
Gender:F
Credentials:MS, RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6750 N MACARTHUR BLVD
Mailing Address - Street 2:STE 350
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-2484
Mailing Address - Country:US
Mailing Address - Phone:817-514-5200
Mailing Address - Fax:
Practice Address - Street 1:6420 N MACARTHUR BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-2837
Practice Address - Country:US
Practice Address - Phone:832-237-3500
Practice Address - Fax:281-897-9906
Is Sole Proprietor?:No
Enumeration Date:2012-07-26
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT07220133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered