Provider Demographics
NPI:1922277490
Name:CURTIS, CAROL CONKLIN (RD, LD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:CONKLIN
Last Name:CURTIS
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:ANN
Other - Last Name:CONKLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9473 FM1960 ROAD W BYPASS
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338
Mailing Address - Country:US
Mailing Address - Phone:281-733-9475
Mailing Address - Fax:281-852-8488
Practice Address - Street 1:700 ROCKMEAD DR
Practice Address - Street 2:SUITE 246
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2103
Practice Address - Country:US
Practice Address - Phone:281-733-9475
Practice Address - Fax:281-852-8488
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-28
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL648286133V00000X
TXDT00759133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered