Basic Information
| Provider Information | |||||||||
| NPI: | 1962750802 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NELSON | ||||||||
| FirstName: | TERRI | ||||||||
| MiddleName: | KELLER | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.S., R.D., L.D.N. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | JOHNSON | ||||||||
| OtherFirstName: | TERRI | ||||||||
| OtherMiddleName: | KELLER | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MS, RD, LDN | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7373 PERKINS RD | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708084326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252469790 | ||||||||
| FaxNumber: | 2252469100 | ||||||||
| Practice Location | |||||||||
| Address1: | 7373 PERKINS RD | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708084326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252469790 | ||||||||
| FaxNumber: | 2252469100 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2012 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133N00000X | 867915 | LA | N | Dietary & Nutritional Service Providers | Nutritionist | 133N00000X | 1273 | LA | N | Dietary & Nutritional Service Providers | Nutritionist | 133V00000X | 1273 | LA | N | Dietary & Nutritional Service Providers | Dietitian, Registered | 133V00000X | 867915 | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.