Provider Demographics
NPI:1780492389
Name:JONES-OLALEYE, CRYSTAL (FUNCTIONAL NUTRITION)
Entity type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:
Last Name:JONES-OLALEYE
Suffix:
Gender:F
Credentials:FUNCTIONAL NUTRITION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70563-1906
Mailing Address - Country:US
Mailing Address - Phone:337-519-5122
Mailing Address - Fax:
Practice Address - Street 1:408 BIRCH ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-1906
Practice Address - Country:US
Practice Address - Phone:337-519-5122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-28
Last Update Date:2024-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA132700000X, 133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No132700000XDietary & Nutritional Service ProvidersDietary Manager