Healthcare Provider Details

I. General information

NPI: 1518837152
Provider Name (Legal Business Name): RAENAH CAMPBELL MS, RDN, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2025
Last Update Date: 11/08/2025
Certification Date: 11/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14110 PAUL HOWELL RD UNIT 243
NORTHPORT AL
35475-4695
US

IV. Provider business mailing address

14110 PAUL HOWELL RD UNIT 243
NORTHPORT AL
35475-4695
US

V. Phone/Fax

Practice location:
  • Phone: 315-436-9010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License Number5734
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: