Provider Demographics
NPI:1104623651
Name:HIERS, REBECCA KAYLEE (RD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:KAYLEE
Last Name:HIERS
Suffix:
Gender:
Credentials:RD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:KAYLEE
Other - Last Name:HUBBARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2120 BLUE HERON COVE DR
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-4929
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2120 BLUE HERON COVE DR
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4929
Practice Address - Country:US
Practice Address - Phone:904-504-2735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND6611133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered