Provider Demographics
NPI:1023520913
Name:CARR, CHELSEA (MS, RD, LDN)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:CARR
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 VILLAGE BLVD APT 402
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-7440
Mailing Address - Country:US
Mailing Address - Phone:913-240-6835
Mailing Address - Fax:
Practice Address - Street 1:3515 VILLAGE BLVD APT 402
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-7440
Practice Address - Country:US
Practice Address - Phone:913-240-6835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-31
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND7902133NN1002X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLND7902OtherFLORDIA STATE LICENSURE
1089706OtherDIETITAN REGISTRATION