Provider Demographics
NPI:1083262117
Name:CARNES, MARLEY OLDHAM (RD)
Entity Type:Individual
Prefix:
First Name:MARLEY
Middle Name:OLDHAM
Last Name:CARNES
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 1:8208 SHASTA DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-7537
Mailing Address - Country:US
Mailing Address - Phone:469-300-1392
Mailing Address - Fax:469-545-0621
Practice Address - Street 1:6136 FRISCO SQUARE BLVD STE 400
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-3251
Practice Address - Country:US
Practice Address - Phone:469-300-1392
Practice Address - Fax:469-545-0621
Is Sole Proprietor?:No
Enumeration Date:2019-09-02
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT85862133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered