Provider Demographics
NPI:1861008757
Name:LAFOUNTAIN, KENDRA R (RDN)
Entity Type:Individual
Prefix:MS
First Name:KENDRA
Middle Name:R
Last Name:LAFOUNTAIN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5732 NORTH DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-2542
Mailing Address - Country:US
Mailing Address - Phone:518-593-1284
Mailing Address - Fax:
Practice Address - Street 1:5732 NORTH DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-2542
Practice Address - Country:US
Practice Address - Phone:518-593-1284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3018133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered