Provider Demographics
NPI:1902030695
Name:MARTIN, KAREN A (MA,RD,FAND,LD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:A
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MA,RD,FAND,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15323 ANTLER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78248-2012
Mailing Address - Country:US
Mailing Address - Phone:210-273-3071
Mailing Address - Fax:
Practice Address - Street 1:15323 ANTLER CREEK DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248-2012
Practice Address - Country:US
Practice Address - Phone:210-273-3071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-08
Last Update Date:2014-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06423133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric