Healthcare Provider Details

I. General information

NPI: 1548767148
Provider Name (Legal Business Name): KARMA DEE HUCK RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 04/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E THORPE ST
LAKIN KS
67860-9625
US

IV. Provider business mailing address

107 WESTVIEW DR
SCOTT CITY KS
67871-1352
US

V. Phone/Fax

Practice location:
  • Phone: 620-355-7111
  • Fax:
Mailing address:
  • Phone: 620-874-1983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number212
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: