Provider Demographics
NPI:1952439945
Name:BALL, MICHELE (MS,RD,LDN)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:BALL
Suffix:
Gender:F
Credentials:MS,RD,LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16777 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-3254
Mailing Address - Country:US
Mailing Address - Phone:225-926-7200
Mailing Address - Fax:225-952-8502
Practice Address - Street 1:16777 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 400
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-3254
Practice Address - Country:US
Practice Address - Phone:225-926-7200
Practice Address - Fax:225-952-8502
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA563133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
4B969Medicare ID - Type Unspecified
P41976Medicare UPIN