Provider Demographics
NPI:1720520018
Name:CORRIERE, KAY S (MS, RDN, LDN)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:S
Last Name:CORRIERE
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:128 HANO ROAD
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447-0069
Mailing Address - Country:US
Mailing Address - Phone:515-559-4257
Mailing Address - Fax:
Practice Address - Street 1:128 HANO RD
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70447-9542
Practice Address - Country:US
Practice Address - Phone:515-559-4257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-17
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2607133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered