Provider Demographics
NPI:1942476502
Name:ASSUNTO, KAREN KIM (RD LD)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:KIM
Last Name:ASSUNTO
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:MRS
Other - First Name:KAREN
Other - Middle Name:KIM
Other - Last Name:ASSUNTO SELLERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD LD
Mailing Address - Street 1:115 AIRPORT ROAD
Mailing Address - Street 2:
Mailing Address - City:SULPHUR SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:74582
Mailing Address - Country:US
Mailing Address - Phone:903-439-4140
Mailing Address - Fax:903-439-0566
Practice Address - Street 1:115 AIRPORT ROAD
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:74582
Practice Address - Country:US
Practice Address - Phone:903-439-4140
Practice Address - Fax:903-439-0566
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06706133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A9115Medicare UPIN