Provider Demographics
NPI:1336305192
Name:CARR, RHONDA KIKER (RD, LD, CDE)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:KIKER
Last Name:CARR
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4813 TIMBER LN
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-2832
Mailing Address - Country:US
Mailing Address - Phone:432-520-8160
Mailing Address - Fax:432-685-1239
Practice Address - Street 1:2200 W ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-6407
Practice Address - Country:US
Practice Address - Phone:432-685-1111
Practice Address - Fax:432-685-1239
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT05107133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8223B6Medicare PIN