Provider Demographics
NPI:1477734945
Name:MCBRIDE, KAREN S (RD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:S
Last Name:MCBRIDE
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 1:9229 LBJ FWY STE 250
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-4403
Mailing Address - Country:US
Mailing Address - Phone:972-739-3097
Mailing Address - Fax:
Practice Address - Street 1:9229 LBJ FWY STE 250
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-4403
Practice Address - Country:US
Practice Address - Phone:972-739-3097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-26
Last Update Date:2008-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT02491133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K1106Medicare PIN
TX8K1104Medicare PIN
TX8K1105Medicare PIN