Provider Demographics
NPI:1578337176
Name:CARTER, REILLY (RD, LDN)
Entity Type:Individual
Prefix:
First Name:REILLY
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1452 NW OGDEN AVE UNIT 2
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-1586
Mailing Address - Country:US
Mailing Address - Phone:828-550-6688
Mailing Address - Fax:
Practice Address - Street 1:1452 NW OGDEN AVE UNIT 2
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-1586
Practice Address - Country:US
Practice Address - Phone:828-550-6688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered