Provider Demographics
NPI:1699310821
Name:BRIGGS, CARLIE ASTON (DTR)
Entity type:Individual
Prefix:
First Name:CARLIE
Middle Name:ASTON
Last Name:BRIGGS
Suffix:
Gender:F
Credentials:DTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4022 E. GREENWAY RD.
Mailing Address - Street 2:STE 11 #175
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032
Mailing Address - Country:US
Mailing Address - Phone:319-429-5978
Mailing Address - Fax:
Practice Address - Street 1:164 WILSON HTS
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-7468
Practice Address - Country:US
Practice Address - Phone:319-429-5978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered