Provider Demographics
NPI:1992370860
Name:BEAVER, KAELI ANGELA (RD, LDN)
Entity Type:Individual
Prefix:
First Name:KAELI
Middle Name:ANGELA
Last Name:BEAVER
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 1:112 LOCH HAVEN LN
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-9710
Mailing Address - Country:US
Mailing Address - Phone:919-830-7138
Mailing Address - Fax:
Practice Address - Street 1:112 LOCH HAVEN LN
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-9710
Practice Address - Country:US
Practice Address - Phone:919-830-7138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL006395133V00000X
NC86150801133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered