Provider Demographics
NPI:1093374753
Name:GILLIKIN, LAURA GASTON (RD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:GASTON
Last Name:GILLIKIN
Suffix:
Gender:
Credentials:RD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:CAULEY
Other - Last Name:GASTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:1700 CREEKSIDE LN
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-3076
Mailing Address - Country:US
Mailing Address - Phone:251-455-4513
Mailing Address - Fax:
Practice Address - Street 1:1700 CREEKSIDE LN
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-3076
Practice Address - Country:US
Practice Address - Phone:251-455-4513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2025-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.011046133V00000X
AL3018133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
1487449187OtherNPI 2