Provider Demographics
NPI:1750891784
Name:EVERETT, REBECCA KILLIAN (RD CDE)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:KILLIAN
Last Name:EVERETT
Suffix:
Gender:F
Credentials:RD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 NORTHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CENTRE
Mailing Address - State:AL
Mailing Address - Zip Code:35960-1023
Mailing Address - Country:US
Mailing Address - Phone:256-927-1429
Mailing Address - Fax:256-927-1435
Practice Address - Street 1:400 NORTHWOOD DR
Practice Address - Street 2:
Practice Address - City:CENTRE
Practice Address - State:AL
Practice Address - Zip Code:35960-1023
Practice Address - Country:US
Practice Address - Phone:256-927-1429
Practice Address - Fax:256-927-1435
Is Sole Proprietor?:No
Enumeration Date:2017-10-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1393133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered