Provider Demographics
NPI:1497250559
Name:INGRAM'S NUTRITION CONSULTATIONS
Entity Type:Organization
Organization Name:INGRAM'S NUTRITION CONSULTATIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/COMMUNITY NUTRITION
Authorized Official - Prefix:
Authorized Official - First Name:JULIETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:318-572-6157
Mailing Address - Street 1:219 E GREGG ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-5158
Mailing Address - Country:US
Mailing Address - Phone:318-572-6157
Mailing Address - Fax:800-708-7349
Practice Address - Street 1:219 E GREGG ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-5158
Practice Address - Country:US
Practice Address - Phone:318-572-6157
Practice Address - Fax:800-708-7349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-29
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty