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NPI Code Detail

MEDICARE: RAINEY GERALD RD

MEDICARE: RAINEY GERALD RD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian3248LA

General Provider Information

NPI Number : 1376331355
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAINEY GERALD RD
Provider Business Mailing Address
First Line : 1745 LONGWOOD DR
Second Line :
City : BATON ROUGE
State : LA
Zip : 70808-1244
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1745 LONGWOOD DR
Second Line :
City : BATON ROUGE
State : LA
Zip : 70808-1244
Country : US
Telephone Number : 225-485-6537
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/29/2025
Last Update Date : 04/29/2025

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