Active NPI
Carol Bradshaw, RDN, LD
- Registered Dietitian
- Lubbock, TX
National Provider Identifier
1104277102
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- DT84291
- Practice address
- 602 Indiana Ave
Lubbock, TX 79415-3364 - Phone
- (806) 775-9363
- NPI assigned
- Jun 30, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | DT84291 | TX | Primary |
Addresses
Primary practice location
602 Indiana Ave
Lubbock, TX 79415-3364
Mailing address
602 Indiana Ave
Lubbock, TX 79415-3364
Phone (806) 775-9363
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DT84291 | TX | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1467244800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1467244800000",
"number": "1104277102",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "602 INDIANA AVE",
"city": "LUBBOCK",
"state": "TX",
"postal_code": "794153364",
"telephone_number": "806-775-9363"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "602 INDIANA AVE",
"city": "LUBBOCK",
"state": "TX",
"postal_code": "794153364",
"telephone_number": "806-775-9363"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRADSHAW",
"first_name": "CAROL",
"credential": "RDN, LD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-06-30",
"last_updated": "2016-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "TX",
"license": "DT84291",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lubbock, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.