Provider Demographics
NPI:1083800734
Name:STEVENS, CAROLE DIANE (RD)
Entity Type:Individual
Prefix:MS
First Name:CAROLE
Middle Name:DIANE
Last Name:STEVENS
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 1:1722 COMANCHE RD
Mailing Address - Street 2:
Mailing Address - City:MCPHERSON
Mailing Address - State:KS
Mailing Address - Zip Code:67460-7075
Mailing Address - Country:US
Mailing Address - Phone:620-345-7113
Mailing Address - Fax:
Practice Address - Street 1:1722 COMANCHE RD
Practice Address - Street 2:
Practice Address - City:MCPHERSON
Practice Address - State:KS
Practice Address - Zip Code:67460-7075
Practice Address - Country:US
Practice Address - Phone:620-345-7113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-17
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1387133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered