Healthcare Provider Details

I. General information

NPI: 1083186688
Provider Name (Legal Business Name): KAELYN CULPEPPER HUCKABY RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2018
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 AGEE AVE SW
CAMDEN AR
71701-4104
US

IV. Provider business mailing address

493 CALDWELL RD
WEST MONROE LA
71291-1631
US

V. Phone/Fax

Practice location:
  • Phone: 318-243-5748
  • Fax:
Mailing address:
  • Phone: 318-243-5748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1961
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: