Provider Demographics
NPI:1710739545
Name:MOLDEN, TAMISHA (RD)
Entity Type:Individual
Prefix:
First Name:TAMISHA
Middle Name:
Last Name:MOLDEN
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 1:609 SAINT FRANCIS PKWY APT 4204
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-6492
Mailing Address - Country:US
Mailing Address - Phone:225-341-0509
Mailing Address - Fax:
Practice Address - Street 1:609 SAINT FRANCIS PKWY APT 4204
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-6492
Practice Address - Country:US
Practice Address - Phone:225-341-0509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3231133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered