Provider Demographics
NPI:1760783518
Name:CARVER, JUDY LORAINE (RD,LD, CDE)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:LORAINE
Last Name:CARVER
Suffix:
Gender:F
Credentials:RD,LD, CDE
Other - Prefix:MRS
Other - First Name:JUDY
Other - Middle Name:LORAINE
Other - Last Name:HUBBARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 PORTER AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:MO
Mailing Address - Zip Code:65605-2365
Mailing Address - Country:US
Mailing Address - Phone:417-678-7980
Mailing Address - Fax:417-678-7864
Practice Address - Street 1:500 PORTER AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:MO
Practice Address - Zip Code:65605-2365
Practice Address - Country:US
Practice Address - Phone:417-678-7980
Practice Address - Fax:417-678-7864
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-10
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001007131133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered