Healthcare Provider Details

I. General information

NPI: 1992543532
Provider Name (Legal Business Name): JOSHUA DAVIS RDN, LDN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2024
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1841 MANDEVILLE ST
NEW ORLEANS LA
70117-8135
US

IV. Provider business mailing address

1841 MANDEVILLE ST
NEW ORLEANS LA
70117-8135
US

V. Phone/Fax

Practice location:
  • Phone: 504-939-9660
  • Fax:
Mailing address:
  • Phone: 504-939-9660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number3560
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number3560
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number3560
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: