Healthcare Provider Details

I. General information

NPI: 1710584982
Provider Name (Legal Business Name): PALMETTO NUTRITION CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2020
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 PATRIOT LN
EDGEMOOR SC
29712-8704
US

IV. Provider business mailing address

531 PATRIOT LN
EDGEMOOR SC
29712-8704
US

V. Phone/Fax

Practice location:
  • Phone: 864-350-8855
  • Fax: 864-794-3578
Mailing address:
  • Phone: 864-350-8855
  • Fax: 864-794-3578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateNULL

VIII. Authorized Official

Name: REBECCA HICKLIN
Title or Position: REGISTERED DIETITIAN
Credential: MS, RD, LD
Phone: 864-350-8885