Provider Demographics
NPI:1134944507
Name:CARTER, CAROLINE (RD)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:CARTER
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 1:211 SUTTLE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-2527
Mailing Address - Country:US
Mailing Address - Phone:913-707-1290
Mailing Address - Fax:
Practice Address - Street 1:211 SUTTLE DR
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-2527
Practice Address - Country:US
Practice Address - Phone:913-707-1290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR86089933133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered