Provider Demographics
NPI:1740070804
Name:NEVILL, CARLY (RD)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:NEVILL
Suffix:
Gender:
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 W HOPKINS ST
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-4313
Mailing Address - Country:US
Mailing Address - Phone:713-412-5616
Mailing Address - Fax:
Practice Address - Street 1:611 W HOPKINS ST
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-4313
Practice Address - Country:US
Practice Address - Phone:713-412-5616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-10
Last Update Date:2025-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT87568133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered