Basic Information
| Provider Information | |||||||||
| NPI: | 1558787713 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ORMS | ||||||||
| FirstName: | CORINNA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RD. LD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 846098 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752846098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9033246450 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 619 S FLEISHEL AVE STE 327 | ||||||||
| Address2: | |||||||||
| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757012019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9036064848 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2014 | ||||||||
| LastUpdateDate: | 10/31/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | DT82270 | TX | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
ID Information
| ID | Type | State | Issuer | Description | 75-2616977-042 | 01 | TX | TRICARE | OTHER | 337110602 | 05 | TX | MEDICAID | 75-0818167-015 | 01 | TX | TRICARE | OTHER | 75-2616977-017 | 01 | TX | TRICARE | OTHER | P01443786 | 01 | TX | RAIL ROAD MEDICARE | OTHER | 337110601 | 05 | TX | MEDICAID | 8EY388 | 01 | TX | BCBS | OTHER | 75-2616977-124 | 01 | TX | TRICARE | OTHER | 8EG498 | 01 | TX | BCBS | OTHER |