Provider Demographics
NPI:1235456310
Name:RICHARDSON, VALERIE A (RD)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:A
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11373 MEADOW VIEW DR
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-6098
Mailing Address - Country:US
Mailing Address - Phone:225-638-5717
Mailing Address - Fax:225-638-5849
Practice Address - Street 1:350 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:NEW ROADS
Practice Address - State:LA
Practice Address - Zip Code:70760-2621
Practice Address - Country:US
Practice Address - Phone:225-638-5717
Practice Address - Fax:225-638-5849
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1429133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered