Provider Demographics
NPI:1942961461
Name:MCGOEY, TIFFANY ANN (RD, LDN)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ANN
Last Name:MCGOEY
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 GARDEN LN
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447-9253
Mailing Address - Country:US
Mailing Address - Phone:985-373-6537
Mailing Address - Fax:
Practice Address - Street 1:503 GARDEN LN
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70447-9253
Practice Address - Country:US
Practice Address - Phone:985-373-6537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2520133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered