Healthcare Provider Details

I. General information

NPI: 1720219793
Provider Name (Legal Business Name): MELISSA MICELI REED RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2009
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61303 BRITTANY DR
LACOMBE LA
70445-2819
US

IV. Provider business mailing address

61303 BRITTANY DR
LACOMBE LA
70445-2819
US

V. Phone/Fax

Practice location:
  • Phone: 985-445-7282
  • Fax:
Mailing address:
  • Phone: 985-445-7282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number1969
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1969
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number1969
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: