Provider Demographics
NPI:1992004519
Name:BALDREE, KAREN ALICIA (RD, CSP, LD)
Entity Type:Individual
Prefix:MISS
First Name:KAREN
Middle Name:ALICIA
Last Name:BALDREE
Suffix:
Gender:F
Credentials:RD, CSP, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 OAKWOOD CT
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31793-5755
Mailing Address - Country:US
Mailing Address - Phone:229-646-6059
Mailing Address - Fax:
Practice Address - Street 1:122 OAKWOOD CT
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31793-5755
Practice Address - Country:US
Practice Address - Phone:229-646-6059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC806133VN1004X
GALD003030133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric