Healthcare Provider Details

I. General information

NPI: 1841066057
Provider Name (Legal Business Name): HALEY WHITEMAN LEBARRON RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HALEY MAREE WHITEMAN RDN

II. Dates (important events)

Enumeration Date: 11/29/2023
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 TRACY WAY STE 2
CHARLESTON WV
25311-1262
US

IV. Provider business mailing address

600 TRACY WAY STE 2
CHARLESTON WV
25311-1262
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-4965
  • Fax:
Mailing address:
  • Phone: 304-388-4965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number1262
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number1262
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1262
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: