Provider Demographics
NPI:1649535840
Name:BOONE, CARIE LYNN (MS, RD, CD)
Entity type:Individual
Prefix:
First Name:CARIE
Middle Name:LYNN
Last Name:BOONE
Suffix:
Gender:
Credentials:MS, RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3012 S WARNER ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-4812
Mailing Address - Country:US
Mailing Address - Phone:253-223-6808
Mailing Address - Fax:
Practice Address - Street 1:3012 S WARNER ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-4812
Practice Address - Country:US
Practice Address - Phone:253-223-6808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-12
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1006966133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered