Provider Demographics
NPI:1275759946
Name:DUPUIS, JUDITH (MS,RD,LDN,CDE,CSR)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:DUPUIS
Suffix:
Gender:F
Credentials:MS,RD,LDN,CDE,CSR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 PROVOST ST APT 202
Mailing Address - Street 2:
Mailing Address - City:SCOTT
Mailing Address - State:LA
Mailing Address - Zip Code:70583-5685
Mailing Address - Country:US
Mailing Address - Phone:337-935-9158
Mailing Address - Fax:
Practice Address - Street 1:3 FLAGG PL STE A2
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-7003
Practice Address - Country:US
Practice Address - Phone:337-935-9158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1689133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4C503Medicare UPIN