Provider Demographics
NPI:1013133248
Name:HOLYFIELD, ANDI (RD, LDN)
Entity Type:Individual
Prefix:
First Name:ANDI
Middle Name:
Last Name:HOLYFIELD
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 1:2821 DEBORAH DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-1943
Mailing Address - Country:US
Mailing Address - Phone:318-340-9306
Mailing Address - Fax:
Practice Address - Street 1:3801 CHAUVIN LN
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-1911
Practice Address - Country:US
Practice Address - Phone:318-387-2352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA894825133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered