Provider Demographics
NPI:1275332207
Name:BARLOW, DEIDRA HOLCOMB (RD,LD, CSP)
Entity type:Individual
Prefix:
First Name:DEIDRA
Middle Name:HOLCOMB
Last Name:BARLOW
Suffix:
Gender:
Credentials:RD,LD, CSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 WILDWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-9477
Mailing Address - Country:US
Mailing Address - Phone:720-415-9883
Mailing Address - Fax:
Practice Address - Street 1:1331 WILDWOOD LN
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-9477
Practice Address - Country:US
Practice Address - Phone:720-415-9883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY325133V00000X
NM2023078133V00000X
CO885042133VN1004X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric