MEDICARE: PRIMARY NUTRITION CONSULTING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1154979250
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMARY NUTRITION CONSULTING LLC

Provider Business Mailing Address
First Line	:	73043 PLANTATION ST
Second Line	:
City	:	COVINGTON
State	:	LA
Zip	:	70435-5917
Country	:	US
Telephone Number	:	985-705-6738
Fax Number	:

Provider Business Practice Location Address
First Line	:	71667 LEVESON ST
Second Line	:
City	:	ABITA SPRINGS
State	:	LA
Zip	:	70420-3635
Country	:	US
Telephone Number	:	985-705-6738
Fax Number	:	985-327-0205

Authorized Official
Title or Position	:	OWNER
Name	:	ROCHELLE AMELIA YOUNG
Credential	:	RD, LDN
Telephone Number	:	985-705-6738

Provider Enumeration Date	:	08/31/2019
Last Update Date	:	06/17/2020

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