Healthcare Provider Details

I. General information

NPI: 1508848623
Provider Name (Legal Business Name): LISA ALLISON-GRAVES POST R.D./ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 S WASHINGTON ST
BASTROP LA
71220-5033
US

IV. Provider business mailing address

PO BOX 1060
BASTROP LA
71221-1060
US

V. Phone/Fax

Practice location:
  • Phone: 318-283-3965
  • Fax:
Mailing address:
  • Phone: 318-283-3607
  • Fax: 318-239-8607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number1937
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number1937
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1937
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number1937
License Number StateLA
# 5
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number1937
License Number StateLA
# 6
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number1937
License Number StateLA
# 7
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD.206986
License Number StateLA
# 8
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD206986
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: