Provider Demographics
NPI:1205179405
Name:WHITLEY, KARLA (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:KARLA
Middle Name:
Last Name:WHITLEY
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:MISS
Other - First Name:KARLA
Other - Middle Name:
Other - Last Name:PICARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN, LDN
Mailing Address - Street 1:10815 SANDPIPER LANE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-4472
Mailing Address - Country:US
Mailing Address - Phone:214-763-7552
Mailing Address - Fax:844-316-9732
Practice Address - Street 1:10815 SANDPIPER LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-4472
Practice Address - Country:US
Practice Address - Phone:214-763-7552
Practice Address - Fax:844-316-9732
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-05
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT02831133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
708159OtherCOMMISSION ON DIETETIC REGISTRATION