Provider Demographics
NPI:1508612706
Name:ROGERS, ELAINE GREY (MPH, RD, LDN, CHC)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:GREY
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MPH, RD, LDN, CHC
Other - Prefix:
Other - First Name:GREY
Other - Middle Name:
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1105 ISLAND PARK BLVD APT 723
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-4768
Mailing Address - Country:US
Mailing Address - Phone:318-470-9825
Mailing Address - Fax:
Practice Address - Street 1:1105 ISLAND PARK BLVD APT 723
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-4768
Practice Address - Country:US
Practice Address - Phone:318-470-9825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic