Healthcare Provider Details

I. General information

NPI: 1417141268
Provider Name (Legal Business Name): CHARLOTTE CAPERTON-KILBURN MS, RD, CSSD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 02/10/2024
Certification Date: 02/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 CHADWICK DR
CHARLESTON SC
29407-7470
US

IV. Provider business mailing address

90 CHADWICK DR
CHARLESTON SC
29407-7470
US

V. Phone/Fax

Practice location:
  • Phone: 842-225-4423
  • Fax: 843-225-4429
Mailing address:
  • Phone: 842-225-4423
  • Fax: 843-225-4429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License Number49
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License Number1165
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number49
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1165
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberD0993
License Number StateMS
# 6
Primary TaxonomyN
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License NumberD0993
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: