Provider Demographics
NPI:1144491994
Name:TAYLOR, CAROL C (RD)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:C
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 S 12TH AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3138
Mailing Address - Country:US
Mailing Address - Phone:509-469-2483
Mailing Address - Fax:
Practice Address - Street 1:451 INGALLS LN
Practice Address - Street 2:
Practice Address - City:WAPATO
Practice Address - State:WA
Practice Address - Zip Code:98951-9678
Practice Address - Country:US
Practice Address - Phone:509-494-3277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-20
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA966736133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered