Provider Demographics
NPI:1831657535
Name:WINGATE, KOURTNEY (RD, LDN, MPH)
Entity Type:Individual
Prefix:
First Name:KOURTNEY
Middle Name:
Last Name:WINGATE
Suffix:
Gender:F
Credentials:RD, LDN, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1645 LUTCHER AVE
Mailing Address - Street 2:
Mailing Address - City:LUTCHER
Mailing Address - State:LA
Mailing Address - Zip Code:70071-5150
Mailing Address - Country:US
Mailing Address - Phone:005-258-2928
Mailing Address - Fax:225-869-5271
Practice Address - Street 1:1645 LUTCHER AVE
Practice Address - Street 2:
Practice Address - City:LUTCHER
Practice Address - State:LA
Practice Address - Zip Code:70071-5150
Practice Address - Country:US
Practice Address - Phone:005-258-2928
Practice Address - Fax:225-869-5271
Is Sole Proprietor?:No
Enumeration Date:2019-03-12
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered