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General NPI Number Information
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NPI Number | 1013472166
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Entity Type | Organization
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Legal Business Name | RED RIVER MEDICAL NUTRITION LLC
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Dates
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Enumeration Date | 02/04/2019
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Last Update Date | 02/21/2019
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Provider Practice Location Address
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Address Line | 1115 E 7TH AVE
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City | OAKDALE
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State | LA
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Zip | 71463-2301
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Country | US
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Telephone | 318-485-9238
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Fax |
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Provider Business Mailing Address
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Address Line | 148 DOUGLAS MEMORIAL RD
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City | LEESVILLE
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State | LA
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Zip | 71446-5404
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Country | US
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Telephone | 318-485-9238
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | ALEXIS D MOTLEY
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Credential | MS, RDN, LDN
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Telephone | 318-485-9238
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133VN1004X
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Taxonomy Name | Pediatric Nutrition Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 133VN1006X
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Taxonomy Name | Metabolic Nutrition Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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