Individual
CARLY LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., R.D., L.D.
Contact information
Practice address
4200 W UNIVERSITY DR, PROSPER, TX 75078-9805
(682) 303-4200
(682) 303-4242
Mailing address
PO BOX 733784, DALLAS, TX 75373-3784
(682) 885-6163
(682) 885-1396
Taxonomy
Speciality
Code
Description
License number
State
133VN1004X
Pediatric Nutrition Registered Dietitian
Primary
DT84424
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DT84424
LICENSED DIETITIAN
—
Enumeration date
09/07/2016
Last updated
08/19/2021
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