Healthcare Provider Details

I. General information

NPI: 1013472166
Provider Name (Legal Business Name): RED RIVER MEDICAL NUTRITION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2019
Last Update Date: 02/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 E 7TH AVE
OAKDALE LA
71463-2301
US

IV. Provider business mailing address

148 DOUGLAS MEMORIAL RD
LEESVILLE LA
71446-5404
US

V. Phone/Fax

Practice location:
  • Phone: 318-485-9238
  • Fax:
Mailing address:
  • Phone: 318-485-9238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: ALEXIS D MOTLEY
Title or Position: MANAGER
Credential: MS, RDN, LDN
Phone: 318-485-9238