Healthcare Provider Details

I. General information

NPI: 1295309201
Provider Name (Legal Business Name): LAUREN PIKE RD, LD, CSSD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2021
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2817 REILLY ST
FORT BRAGG NC
28310-7324
US

IV. Provider business mailing address

2817 REILLY ST
FORT BRAGG NC
28310-7324
US

V. Phone/Fax

Practice location:
  • Phone: 910-907-8922
  • Fax: 910-907-6069
Mailing address:
  • Phone: 910-907-8922
  • Fax: 910-907-6069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: