Provider Demographics
NPI:1669764395
Name:MCGILBERRY, BALEANA WATTS (RDN, LDN, CDCES)
Entity type:Individual
Prefix:MRS
First Name:BALEANA
Middle Name:WATTS
Last Name:MCGILBERRY
Suffix:
Gender:F
Credentials:RDN, LDN, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 NOTTINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:SEMMES
Mailing Address - State:AL
Mailing Address - Zip Code:36575-8218
Mailing Address - Country:US
Mailing Address - Phone:251-459-0695
Mailing Address - Fax:251-459-0695
Practice Address - Street 1:4110 NOTTINGHAM DR
Practice Address - Street 2:
Practice Address - City:SEMMES
Practice Address - State:AL
Practice Address - Zip Code:36575-8218
Practice Address - Country:US
Practice Address - Phone:251-459-0695
Practice Address - Fax:251-459-0695
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-13
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL917122133NN1002X, 133N00000X, 133VN1004X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSD1106OtherMISSISSIPPI STATE LICENSE
AL1712OtherALABAMA STATE LICENSE