Provider Demographics
NPI:1245510247
Name:BOSWELL, KARA (RAE) RAE (MS, RD, LD)
Entity type:Individual
Prefix:MRS
First Name:KARA (RAE)
Middle Name:RAE
Last Name:BOSWELL
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:MISS
Other - First Name:KARA
Other - Middle Name:RAE
Other - Last Name:HANAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, LD
Mailing Address - Street 1:400 CHISHOLM PL
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-6938
Mailing Address - Country:US
Mailing Address - Phone:972-422-9180
Mailing Address - Fax:
Practice Address - Street 1:630 N KIMBALL AVE STE 110
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6887
Practice Address - Country:US
Practice Address - Phone:972-422-9180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT85489133V00000X
OK1778133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered