Provider Demographics
NPI:1356118038
Name:CARRICK, TAYLOR SANDRA (MS, RDN, LMNT, LD)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:SANDRA
Last Name:CARRICK
Suffix:
Gender:F
Credentials:MS, RDN, LMNT, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 HARNEY ST APT 404
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68102-2275
Mailing Address - Country:US
Mailing Address - Phone:712-370-2261
Mailing Address - Fax:
Practice Address - Street 1:10004 S 152ND ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68138-3930
Practice Address - Country:US
Practice Address - Phone:402-896-7953
Practice Address - Fax:833-719-1241
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1754133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered