Provider Demographics
NPI:1740411248
Name:LARSEN, MEREDITH L (RD/LD)
Entity Type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:L
Last Name:LARSEN
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 1:3295 S COOPER ST
Mailing Address - Street 2:SUITE 131
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-2363
Mailing Address - Country:US
Mailing Address - Phone:817-557-0099
Mailing Address - Fax:817-417-7266
Practice Address - Street 1:3295 S COOPER ST
Practice Address - Street 2:SUITE 131
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2363
Practice Address - Country:US
Practice Address - Phone:817-557-0099
Practice Address - Fax:817-417-7266
Is Sole Proprietor?:No
Enumeration Date:2009-07-31
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT80374133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal