Provider Demographics
NPI:1679574305
Name:YOKUM, LAURA CAMILLE (RD)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:CAMILLE
Last Name:YOKUM
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MRS
Other - First Name:LAURA
Other - Middle Name:KIM
Other - Last Name:YOKUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:HC 59 BOX 4
Mailing Address - Street 2:
Mailing Address - City:SENECA ROCKS
Mailing Address - State:WV
Mailing Address - Zip Code:26884-9526
Mailing Address - Country:US
Mailing Address - Phone:304-567-2488
Mailing Address - Fax:
Practice Address - Street 1:24 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26847-1518
Practice Address - Country:US
Practice Address - Phone:304-257-1044
Practice Address - Fax:304-257-2681
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV30133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVWV LICENSE NO . 30OtherSTATE LICENSE
WVR580231OtherNATIONAL ADA REGISTRATION
WVWV LICENSE NO . 30OtherSTATE LICENSE