Provider Demographics
NPI:1518214501
Name:GUILLORY, MELISSA (RD, LDN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:GUILLORY
Suffix:
Gender:F
Credentials: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:P.O. BOX 95
Mailing Address - Street 2:
Mailing Address - City:OSCAR
Mailing Address - State:LA
Mailing Address - Zip Code:70762
Mailing Address - Country:US
Mailing Address - Phone:225-637-3348
Mailing Address - Fax:
Practice Address - Street 1:7173-A FLORIDA BOULEVARD
Practice Address - Street 2:BON CARRE BUSINESS PARK
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806
Practice Address - Country:US
Practice Address - Phone:225-925-7231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA485133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered