Healthcare Provider Details

I. General information

NPI: 1114720182
Provider Name (Legal Business Name): ANNE BARRET CAMPBELL BUTLER MPH RD LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2025
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 BLYTHE BLVD STE 200
CHARLOTTE NC
28203-5865
US

IV. Provider business mailing address

1001 BLYTHE BLVD STE 200
CHARLOTTE NC
28203-5865
US

V. Phone/Fax

Practice location:
  • Phone: 704-756-5280
  • Fax:
Mailing address:
  • Phone: 704-756-5280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberL001545
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: