Healthcare Provider Details

I. General information

NPI: 1144967340
Provider Name (Legal Business Name): MEGAN PARKER RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN PASSALAQUA RD, LDN

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 JEFFERSON HWY
JEFFERSON LA
70121-2429
US

IV. Provider business mailing address

321 FLORIDA ST
RIVER RIDGE LA
70123-1103
US

V. Phone/Fax

Practice location:
  • Phone: 866-624-7637
  • Fax:
Mailing address:
  • Phone: 504-275-4307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2887
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: