Provider Demographics
NPI:1073298733
Name:DOUGET, ERIN (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:DOUGET
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1892
Mailing Address - Street 2:
Mailing Address - City:TUNICA
Mailing Address - State:MS
Mailing Address - Zip Code:38676-1892
Mailing Address - Country:US
Mailing Address - Phone:901-299-4605
Mailing Address - Fax:
Practice Address - Street 1:1230 HOUSTON LN
Practice Address - Street 2:
Practice Address - City:TUNICA
Practice Address - State:MS
Practice Address - Zip Code:38676-9139
Practice Address - Country:US
Practice Address - Phone:901-299-4605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-20
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3512133V00000X
LA2462133V00000X
MS1673133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered