Individual
KATHY PUCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDLDCDE
Contact information
Practice address
98 POPLAR ST, BLACKFOOT, ID 83221-1758
(208) 785-4100
(208) 785-8959
Mailing address
98 POPLAR ST, BLACKFOOT, ID 83221-1758
(208) 785-4100
(208) 785-8959
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
D-361
ID
Other
Enumeration date
07/01/2010
Last updated
10/04/2010
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