Provider Demographics
NPI:1891169900
Name:HUDDLE, COURTNEY (MS RDN LDN)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:
Last Name:HUDDLE
Suffix:
Gender:F
Credentials:MS RDN LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E W T HARRIS BLVD STE 2122B
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-3485
Mailing Address - Country:US
Mailing Address - Phone:704-863-6549
Mailing Address - Fax:
Practice Address - Street 1:101 E W T HARRIS BLVD STE 2122B
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-3485
Practice Address - Country:US
Practice Address - Phone:704-863-6549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004665133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered