Provider Demographics
NPI:1649526625
Name:GIBBS, MONICA LYNN (RD, LDN)
Entity type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:LYNN
Last Name:GIBBS
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 1:102 PINTAIL DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70507-4948
Mailing Address - Country:US
Mailing Address - Phone:337-234-3469
Mailing Address - Fax:
Practice Address - Street 1:825 KALISTE SALOOM RD
Practice Address - Street 2:BRANDYWINE 3; SUITE 100
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-4284
Practice Address - Country:US
Practice Address - Phone:337-262-2271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA130133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered