Provider Demographics
NPI:1326446535
Name:WETMORE, CARLEIGH SIMMONS (RD, LDN, CDE)
Entity Type:Individual
Prefix:
First Name:CARLEIGH
Middle Name:SIMMONS
Last Name:WETMORE
Suffix:
Gender:F
Credentials:RD, LDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 YADKIN ST
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-3441
Mailing Address - Country:US
Mailing Address - Phone:980-323-4722
Mailing Address - Fax:980-323-5162
Practice Address - Street 1:301 YADKIN ST
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-3441
Practice Address - Country:US
Practice Address - Phone:980-323-4722
Practice Address - Fax:980-323-5162
Is Sole Proprietor?:No
Enumeration Date:2014-12-22
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004519133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered