Provider Demographics
NPI:1346772282
Name:CAUDELL, KARLY (RD)
Entity Type:Individual
Prefix:
First Name:KARLY
Middle Name:
Last Name:CAUDELL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 S LINDEN RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-5473
Mailing Address - Country:US
Mailing Address - Phone:517-231-2896
Mailing Address - Fax:
Practice Address - Street 1:2425 S LINDEN RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-5473
Practice Address - Country:US
Practice Address - Phone:517-231-2896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered