Provider Demographics
NPI:1790799195
Name:MCLAIN, AUDRA L (MS, LDN, RD)
Entity Type:Individual
Prefix:
First Name:AUDRA
Middle Name:L
Last Name:MCLAIN
Suffix:
Gender:F
Credentials:MS, LDN, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGHILL
Mailing Address - State:LA
Mailing Address - Zip Code:71075-4526
Mailing Address - Country:US
Mailing Address - Phone:318-539-1000
Mailing Address - Fax:318-539-4085
Practice Address - Street 1:2001 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:SPRINGHILL
Practice Address - State:LA
Practice Address - Zip Code:71075-4526
Practice Address - Country:US
Practice Address - Phone:318-539-1000
Practice Address - Fax:318-539-4085
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1680133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA896972OtherREGISTERED DIETITIAN
LA1680OtherDIETITIAN STATE LICENSE
LA896972OtherREGISTERED DIETITIAN