MEDICARE: RAINEY GERALD RD

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	3248	LA

General Provider Information

NPI Number	:	1376331355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAINEY GERALD RD

Provider Business Mailing Address
First Line	:	1745 LONGWOOD DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70808-1244
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1745 LONGWOOD DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70808-1244
Country	:	US
Telephone Number	:	225-485-6537
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2025
Last Update Date	:	04/29/2025

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