Provider Demographics
NPI:1659559581
Name:ITZ-THOMPSON, KARRIE (RD, LD)
Entity Type:Individual
Prefix:
First Name:KARRIE
Middle Name:
Last Name:ITZ-THOMPSON
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 1:1105 FM 1863
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132-4648
Mailing Address - Country:US
Mailing Address - Phone:210-822-5959
Mailing Address - Fax:
Practice Address - Street 1:1105 FM 1863
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78132-4648
Practice Address - Country:US
Practice Address - Phone:210-822-5959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-01
Last Update Date:2018-03-17
Deactivation Date:2017-11-21
Deactivation Code:
Reactivation Date:2017-12-26
Provider Licenses
StateLicense IDTaxonomies
TXDT07241133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered