Healthcare Provider Details

I. General information

NPI: 1275949596
Provider Name (Legal Business Name): LAUREN HUCKABEE R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2014
Last Update Date: 06/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

816 22ND AVE STE 100
KEARNEY NE
68845-2226
US

IV. Provider business mailing address

816 22ND AVE STE 100
KEARNEY NE
68845-2226
US

V. Phone/Fax

Practice location:
  • Phone: 308-865-2263
  • Fax: 308-865-2541
Mailing address:
  • Phone: 308-865-2263
  • Fax: 308-865-2541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1121
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: