Provider Demographics
NPI:1891343893
Name:GARRETT, CONNIE J (RD)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:J
Last Name:GARRETT
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:J
Other - Last Name:CORTEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3343 S WELWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-5402
Mailing Address - Country:US
Mailing Address - Phone:417-343-8187
Mailing Address - Fax:
Practice Address - Street 1:3343 S WELWOOD AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-5402
Practice Address - Country:US
Practice Address - Phone:417-343-8187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered