Carly Lewis, M.S., R.D., L.D.

Primary specialty

Pediatric Nutrition Registered DietitianTaxonomy code 133VN1004X

License

DT84424 Issued in TX

Practice address

4200 W University Dr
Prosper, TX 75078-9805

Phone

(682) 303-4200

Fax

(682) 303-4242

NPI assigned

Sep 7, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: clewis162736@cookchildrens.direct-ci.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cook Children'S Physician Network

  • Pediatrics Physician
  • Fort Worth, TX
  • NPI 1083472062
  NPD
• Cook Children'S Physician Network

  • Pediatrics Physician
  • Fort Worth, TX
  • NPI 1750369203
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1473206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629331200000",
    "number": "1215484175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 733784",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753733784",
            "telephone_number": "682-885-6163",
            "fax_number": "682-885-1396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4200 W UNIVERSITY DR",
            "city": "PROSPER",
            "state": "TX",
            "postal_code": "750789805",
            "telephone_number": "682-303-4200",
            "fax_number": "682-303-4242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEWIS",
        "first_name": "CARLY",
        "credential": "M.S., R.D., L.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-07",
        "last_updated": "2021-08-19",
        "certification_date": "2021-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133VN1004X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Pediatric",
            "state": "TX",
            "license": "DT84424",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSED DIETITIAN",
            "identifier": "DT84424",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "clewis162736@CookChildrens.direct-ci.com",
            "affiliation": "N",
            "address_1": "4200 W University Dr",
            "city": "Prosper",
            "state": "TX",
            "country_code": "US",
            "postal_code": "750789805",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kindsay Delaine Leite, CPNP
• Emily Lemon, M.S., CCC-SLP
• Maya Leno
• Madison Renee Leonard
• Brielle Lewis
• Harrison Lewis III, PA-C
• Allison Leyer
• Little Stars Pediatrics PLLC
• Littlesteps Star LLC
• Live Your Best Life Counseling Services, PLLC

• Pediatric Nutrition Registered Dietitian in Prosper, TX
• Providers in Prosper, TX by specialty
• Pediatric Nutrition Registered Dietitian in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.