Healthcare Provider Details

I. General information

NPI: 1861734071
Provider Name (Legal Business Name): REBEKAH D'ANGELO MCALLISTER MA, RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2013
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 RIVER OAKS DR
LA PLACE LA
70068-7100
US

IV. Provider business mailing address

1311 N GENERAL PERSHING ST
HAMMOND LA
70401-1727
US

V. Phone/Fax

Practice location:
  • Phone: 985-651-2342
  • Fax: 888-573-1919
Mailing address:
  • Phone: 985-634-0722
  • Fax: 985-345-2211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number1296
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number1296
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1296
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: