Provider Demographics
NPI:1013095439
Name:STAPLETON, CAROL MACE (RD LD)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:MACE
Last Name:STAPLETON
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 E DORTON BLVD
Mailing Address - Street 2:
Mailing Address - City:STAFFORDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41256-9038
Mailing Address - Country:US
Mailing Address - Phone:606-279-6557
Mailing Address - Fax:
Practice Address - Street 1:630 JAMES TRIMBLE BLVD
Practice Address - Street 2:
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240-1026
Practice Address - Country:US
Practice Address - Phone:606-789-2590
Practice Address - Fax:606-789-8237
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-1546133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYKY-1546OtherKY BOARD OF LICENSURE
KYKY-1546OtherKY BOARD OF LICENSURE