Healthcare Provider Details

I. General information

NPI: 1255712410
Provider Name (Legal Business Name): VESTA BATCHELDER LDN RD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2015
Last Update Date: 06/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 MACK LN
MADISONVILLE LA
70447-9547
US

IV. Provider business mailing address

214 MACK LN
MADISONVILLE LA
70447-9547
US

V. Phone/Fax

Practice location:
  • Phone: 985-264-8334
  • Fax: 985-206-5141
Mailing address:
  • Phone: 985-264-8334
  • Fax: 985-206-5141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number281
License Number StateLA

VIII. Authorized Official

Name: MRS. VESTA JOHNSON BATCHELDER
Title or Position: DIETITIAN
Credential: RD
Phone: 985-264-8334