Provider Demographics
NPI:1821557125
Name:MYATT, CARINA BRYELLE (MS, RDN, LD)
Entity Type:Individual
Prefix:MRS
First Name:CARINA
Middle Name:BRYELLE
Last Name:MYATT
Suffix:
Gender:F
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4804 BEDFORD AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-4537
Mailing Address - Country:US
Mailing Address - Phone:325-245-9122
Mailing Address - Fax:
Practice Address - Street 1:5407 ANDREWS HWY
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79706-2851
Practice Address - Country:US
Practice Address - Phone:325-245-9122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-16
Last Update Date:2019-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT84261133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty