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General NPI Number Information
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NPI Number | 1629899117
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Entity Type | Individual
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Provider Name | LATORIA WILHITE RD, LDN
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Gender | Female
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Dates
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Enumeration Date | 10/18/2024
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Last Update Date | 10/18/2024
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Provider Practice Location Address
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Address Line | 3724 JEFFERSON ST STE 104
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City | AUSTIN
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State | TX
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Zip | 78731-6204
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Country | US
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Telephone | 512-693-7045
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Fax |
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Provider Business Mailing Address
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Address Line | 126 LINER DR
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City | MONROE
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State | LA
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Zip | 71203-2974
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Country | US
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Telephone | 318-680-6467
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | DT91165
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License Number State | TX
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