Provider Demographics
NPI:1780030007
Name:CALDWELL, REBECCA (RD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:CALDWELL
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 1:985 WILSON RD
Mailing Address - Street 2:
Mailing Address - City:WATER VALLEY
Mailing Address - State:KY
Mailing Address - Zip Code:42085-9546
Mailing Address - Country:US
Mailing Address - Phone:731-335-3555
Mailing Address - Fax:
Practice Address - Street 1:225 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 304
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-7914
Practice Address - Country:US
Practice Address - Phone:270-217-8282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY225318133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered