Provider Demographics
NPI:1891191383
Name:KEYSTONE PARTNERS, LLC
Entity Type:Organization
Organization Name:KEYSTONE PARTNERS, LLC
Other - Org Name:KEY STONE PARTNERS, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NUTRITION CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:RD,LDN
Authorized Official - Phone:337-356-2244
Mailing Address - Street 1:101 VINEMONT DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-6579
Mailing Address - Country:US
Mailing Address - Phone:337-356-2244
Mailing Address - Fax:
Practice Address - Street 1:101 VINEMONT DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-6579
Practice Address - Country:US
Practice Address - Phone:337-356-2244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-10
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2522133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA263006389OtherTAX ID 263006389