Provider Demographics
NPI:1083186688
Name:HUCKABY, KAELYN CULPEPPER (RD, LDN)
Entity Type:Individual
Prefix:
First Name:KAELYN
Middle Name:CULPEPPER
Last Name:HUCKABY
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:493 CALDWELL RD
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-1631
Mailing Address - Country:US
Mailing Address - Phone:318-243-5748
Mailing Address - Fax:
Practice Address - Street 1:493 CALDWELL RD
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-1631
Practice Address - Country:US
Practice Address - Phone:318-243-5748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2945133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered