Provider Demographics
NPI:1013253962
Name:TOLBERT, CAROLYN BURWELL (RD)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:BURWELL
Last Name:TOLBERT
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 1:9003 AIRPORT FWY STE 300
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-9628
Mailing Address - Country:US
Mailing Address - Phone:817-514-5200
Mailing Address - Fax:
Practice Address - Street 1:9003 AIRPORT FWY STE 300
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-9628
Practice Address - Country:US
Practice Address - Phone:817-514-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-21
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT03902133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered