Provider Demographics
NPI:1558787713
Name:ORMS, CORINNA (RD LD)
Entity Type:Individual
Prefix:MRS
First Name:CORINNA
Middle Name:
Last Name:ORMS
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:PO BOX 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-324-6450
Mailing Address - Fax:
Practice Address - Street 1:619 S FLEISHEL AVE STE 327
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2019
Practice Address - Country:US
Practice Address - Phone:903-606-4848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-12
Last Update Date:2015-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT82270133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX75-2616977-042OtherTRICARE
TX337110602Medicaid
TX75-0818167-015OtherTRICARE
TX75-2616977-017OtherTRICARE
TXP01443786OtherRAIL ROAD MEDICARE
TX337110601Medicaid
TX8EY388OtherBCBS
TX75-2616977-124OtherTRICARE
TX8EG498OtherBCBS
TX347047YMAFMedicare PIN
TXP01443786OtherRAIL ROAD MEDICARE
TX337110601Medicaid