Provider Demographics
NPI:1376788174
Name:PICHON, BARBARA JO (RD LD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:JO
Last Name:PICHON
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:JO
Other - Last Name:WALLIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD
Mailing Address - Street 1:9500 INDEPENDENCE DR
Mailing Address - Street 2:SUITE 900
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-4615
Mailing Address - Country:US
Mailing Address - Phone:907-522-1341
Mailing Address - Fax:907-522-1343
Practice Address - Street 1:9500 INDEPENDENCE DR
Practice Address - Street 2:SUITE 900
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-4615
Practice Address - Country:US
Practice Address - Phone:907-522-1341
Practice Address - Fax:907-522-1343
Is Sole Proprietor?:No
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK139133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered