Provider Demographics
NPI:1467156117
Name:BRAXTON, RACHEL MCCLURE (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:MCCLURE
Last Name:BRAXTON
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 1:1605 FLORIDA ST
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-0733
Mailing Address - Country:US
Mailing Address - Phone:704-685-7594
Mailing Address - Fax:
Practice Address - Street 1:1605 FLORIDA ST
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-0733
Practice Address - Country:US
Practice Address - Phone:704-685-7594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL005963133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered