Provider Demographics
NPI:1417141268
Name:CAPERTON-KILBURN, CHARLOTTE (MS, RD, CSSD, LDN)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:
Last Name:CAPERTON-KILBURN
Suffix:
Gender:F
Credentials:MS, RD, CSSD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 CHADWICK DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-7470
Mailing Address - Country:US
Mailing Address - Phone:842-225-4423
Mailing Address - Fax:843-225-4429
Practice Address - Street 1:90 CHADWICK DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7470
Practice Address - Country:US
Practice Address - Phone:842-225-4423
Practice Address - Fax:843-225-4429
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2024-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC49133VN1501X, 133V00000X
TN1165133VN1501X, 133V00000X
MSD0993133V00000X, 133VN1501X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics