Individual
MS. KIM SHACKLEFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNTP
Contact information
Practice address
3830 CASEY LEIGH LN, RALEIGH, NC 27612-4258
(919) 427-5946
Mailing address
3830 CASEY LEIGH LN, RALEIGH, NC 27612-4258
(919) 427-5946
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
—
—
Other
Enumeration date
07/29/2022
Last updated
07/29/2022
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