Provider Demographics
NPI:1972822641
Name:SNOPEK, CARLA RUSSELL (RD)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:RUSSELL
Last Name:SNOPEK
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 LAKELAND DR
Mailing Address - Street 2:SUITE 517
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-3017
Mailing Address - Country:US
Mailing Address - Phone:601-932-2140
Mailing Address - Fax:
Practice Address - Street 1:513 KEYWOOD CIR
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-3019
Practice Address - Country:US
Practice Address - Phone:601-933-1136
Practice Address - Fax:601-948-3649
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-20
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS816364133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered