Provider Demographics
NPI:1922012145
Name:NOE, CARLY ANN (RD, LDN, CNSC)
Entity Type:Individual
Prefix:MRS
First Name:CARLY
Middle Name:ANN
Last Name:NOE
Suffix:
Gender:F
Credentials:RD, LDN, CNSC
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:ANN
Other - Last Name:HOUSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LDN, CNSC
Mailing Address - Street 1:6511 BRIDLEWAY DRIVE
Mailing Address - Street 2:
Mailing Address - City:COLLEGE GROVE
Mailing Address - State:TN
Mailing Address - Zip Code:37046
Mailing Address - Country:US
Mailing Address - Phone:630-212-5272
Mailing Address - Fax:
Practice Address - Street 1:6511 BRIDLEWAY DRIVE
Practice Address - Street 2:
Practice Address - City:COLLEGE GROVE
Practice Address - State:TN
Practice Address - Zip Code:37046
Practice Address - Country:US
Practice Address - Phone:630-212-5272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.004442133V00000X
TN2247133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered