Provider Demographics
NPI:1609812833
Name:DURHAM, CELESTE (RD)
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:
Last Name:DURHAM
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 1:2101 HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:GAUTIER
Mailing Address - State:MS
Mailing Address - Zip Code:39553-5340
Mailing Address - Country:US
Mailing Address - Phone:228-497-8874
Mailing Address - Fax:228-497-8869
Practice Address - Street 1:2101 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:GAUTIER
Practice Address - State:MS
Practice Address - Zip Code:39553-5340
Practice Address - Country:US
Practice Address - Phone:228-497-8874
Practice Address - Fax:228-497-8869
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA819133V00000X
MS724667133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered