Provider Demographics
NPI:1386319580
Name:KARUA, JERIOTH MUTHONI (MCN, RDN, LD)
Entity type:Individual
Prefix:
First Name:JERIOTH
Middle Name:MUTHONI
Last Name:KARUA
Suffix:
Gender:F
Credentials:MCN, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 HIGHWAY 360 APT 418
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039-5388
Mailing Address - Country:US
Mailing Address - Phone:409-504-7044
Mailing Address - Fax:
Practice Address - Street 1:2525 HIGHWAY 360 APT 418
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76039-5388
Practice Address - Country:US
Practice Address - Phone:409-504-7044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-10
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT86938133VN1201X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight ManagementGroup - Multi-Specialty