Provider Demographics
NPI:1093821456
Name:TORRENCE-KING, CONNIE YVETTE (MS,RD)
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:YVETTE
Last Name:TORRENCE-KING
Suffix:
Gender:F
Credentials:MS,RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15114 WOODSTONE DR
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-8303
Mailing Address - Country:US
Mailing Address - Phone:225-673-6209
Mailing Address - Fax:225-642-1931
Practice Address - Street 1:15114 WOODSTONE DR
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-8303
Practice Address - Country:US
Practice Address - Phone:225-673-6209
Practice Address - Fax:225-642-1931
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA892133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered