Provider Demographics
NPI:1801127055
Name:CAMPBELL, HEATHER SUTPHEN (MS, RD, LD)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:SUTPHEN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:MARIE
Other - Last Name:SUTPHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, LD
Mailing Address - Street 1:406 LONGWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:PIKE ROAD
Mailing Address - State:AL
Mailing Address - Zip Code:36064-2720
Mailing Address - Country:US
Mailing Address - Phone:402-981-1844
Mailing Address - Fax:
Practice Address - Street 1:406 LONGWOOD TRL
Practice Address - Street 2:
Practice Address - City:PIKE ROAD
Practice Address - State:AL
Practice Address - Zip Code:36064-2720
Practice Address - Country:US
Practice Address - Phone:402-981-1844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-27
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist