Individual
MRS. ELYSE MARIE CARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS RD LD
Contact information
Practice address
6135 LA VISTA DR, DALLAS, TX 75214-4310
(214) 773-6858
Mailing address
6135 LA VISTA DR, DALLAS, TX 75214-4310
(214) 773-6858
Taxonomy
Speciality
Code
Description
License number
State
133VN1004X
Pediatric Nutrition Registered Dietitian
Primary
DTO5996
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
143738601
—
TX
01
—
896525
CDR
TX
01
—
DTO5996
TEXAS LICENSURE
TX
Enumeration date
09/13/2006
Last updated
02/21/2012
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