Healthcare Provider Details

I. General information

NPI: 1144767815
Provider Name (Legal Business Name): CALLIE R HUNEYCUTT RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CALLIE E RICKETTS RD, LDN

II. Dates (important events)

Enumeration Date: 01/19/2017
Last Update Date: 03/14/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 REGIONAL DR
PINEHURST NC
28374-8850
US

IV. Provider business mailing address

205 PAGE RD
PINEHURST NC
28374-8749
US

V. Phone/Fax

Practice location:
  • Phone: 910-235-3492
  • Fax:
Mailing address:
  • Phone: 910-295-5511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL004992
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: