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: 12/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

493 CALDWELL RD
WEST MONROE LA
71291-1631
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 Number2945
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: