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General NPI Number Information
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NPI Number | 1912163783
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Entity Type | Organization
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Legal Business Name | PRODIGY NUTRITIONAL CONSULTING, LLC
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Dates
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Enumeration Date | 07/31/2008
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Last Update Date | 07/31/2008
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Provider Practice Location Address
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Address Line | 5635 MAIN ST STE A 238
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City | ZACHARY
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State | LA
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Zip | 70791-4083
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Country | US
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Telephone | 225-247-0074
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Fax |
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Provider Business Mailing Address
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Address Line | 5635 MAIN ST STE A 238
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City | ZACHARY
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State | LA
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Zip | 70791-4083
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | CHANTELLE DENISE JONES
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Credential | RD, LDN
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Telephone | 225-247-0074
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | 2070
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 2070
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License Number State | LA
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