Provider Demographics
NPI:1467095208
Name:BRUBAKER PEACHEY, KAHLI J (RD)
Entity Type:Individual
Prefix:
First Name:KAHLI
Middle Name:J
Last Name:BRUBAKER PEACHEY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:KAHLI
Other - Middle Name:J
Other - Last Name:PEACHEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:6447 STATE ROUTE 655
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17004-9249
Mailing Address - Country:US
Mailing Address - Phone:717-437-5000
Mailing Address - Fax:
Practice Address - Street 1:6447 STATE ROUTE 655
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:PA
Practice Address - Zip Code:17004-9249
Practice Address - Country:US
Practice Address - Phone:717-437-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86076182133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered