Provider Demographics
NPI:1114233293
Name:MEDRANO, KARMY (RD, LD)
Entity Type:Individual
Prefix:
First Name:KARMY
Middle Name:
Last Name:MEDRANO
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 W LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77301-2220
Mailing Address - Country:US
Mailing Address - Phone:915-491-4419
Mailing Address - Fax:281-292-2002
Practice Address - Street 1:1030 W LEWIS ST
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-2220
Practice Address - Country:US
Practice Address - Phone:915-491-4419
Practice Address - Fax:281-292-2002
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT03394133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered