Provider Demographics
NPI:1760861710
Name:CARLSON, AMY BETH (MS, RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:BETH
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4418 CEDAR RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77059-3116
Mailing Address - Country:US
Mailing Address - Phone:713-294-5177
Mailing Address - Fax:
Practice Address - Street 1:4418 CEDAR RIDGE TRL
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77059-3116
Practice Address - Country:US
Practice Address - Phone:713-294-5177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT05474133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered