Provider Demographics
NPI:1790192896
Name:BEARG, CARRI LEIGH (RD, LD)
Entity type:Individual
Prefix:
First Name:CARRI
Middle Name:LEIGH
Last Name:BEARG
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3809 CAMINO DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-3445
Mailing Address - Country:US
Mailing Address - Phone:972-658-2737
Mailing Address - Fax:469-613-0859
Practice Address - Street 1:550 S WATTERS RD
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-5223
Practice Address - Country:US
Practice Address - Phone:972-658-2737
Practice Address - Fax:469-613-0859
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-21
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX133V00000X
TXDT81905133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDT81905OtherREGISTERED DIETITIAN