Provider Demographics
NPI:1134475254
Name:QUEBEDEAUX, TRACI (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:QUEBEDEAUX
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 1:107 KEENELAND LN
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-6213
Mailing Address - Country:US
Mailing Address - Phone:337-262-5616
Mailing Address - Fax:337-262-4976
Practice Address - Street 1:201 W. WILLOW ST BLDG A
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501
Practice Address - Country:US
Practice Address - Phone:337-262-5616
Practice Address - Fax:337-262-4976
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-26
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1376133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered