Provider Demographics
NPI:1083659056
Name:MESSER, CAROLYN K (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:K
Last Name:MESSER
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2413 KACIE LN
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-8258
Mailing Address - Country:US
Mailing Address - Phone:904-806-4547
Mailing Address - Fax:
Practice Address - Street 1:2413 KACIE LN
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-8258
Practice Address - Country:US
Practice Address - Phone:904-806-4547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 1844133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered