Basic Information
| Provider Information | |||||||||
| NPI: | 1164964458 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRIGSBY | ||||||||
| FirstName: | BARBARA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LDN, RD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 OPELOUSAS ST | ||||||||
| Address2: | |||||||||
| City: | LAKE CHARLES | ||||||||
| State: | LA | ||||||||
| PostalCode: | 706012641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3374399983 | ||||||||
| FaxNumber: | 3373101161 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 OPELOUSAS ST | ||||||||
| Address2: | |||||||||
| City: | LAKE CHARLES | ||||||||
| State: | LA | ||||||||
| PostalCode: | 706012641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3374399983 | ||||||||
| FaxNumber: | 3373101161 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2016 | ||||||||
| LastUpdateDate: | 11/17/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133N00000X | 1020 | LA | N | Dietary & Nutritional Service Providers | Nutritionist | 133V00000X | 1020 | LA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
ID Information
| ID | Type | State | Issuer | Description | 1020 | 01 | LA | LICENSED DIETITIAN/NUTRIRTIONIST | OTHER | 455233 | 01 | LA | COMMISSION ON DIETETIC REGISTRATION CREDENTIAL VERIFICATION CERTIFICATE | OTHER |