Provider Demographics
NPI:1871893099
Name:MIDDLETON, CANDACE HOLLIEANNA (RD, LD)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:HOLLIEANNA
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2257 QUILLEN CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:CAMPTON
Mailing Address - State:KY
Mailing Address - Zip Code:41301-8354
Mailing Address - Country:US
Mailing Address - Phone:606-422-9502
Mailing Address - Fax:
Practice Address - Street 1:3015 QUILLEN CHAPEL RD.
Practice Address - Street 2:
Practice Address - City:CAMPTON
Practice Address - State:KY
Practice Address - Zip Code:41301
Practice Address - Country:US
Practice Address - Phone:606-668-7494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-22
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2172133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered