Provider Demographics
NPI:1124226303
Name:MASSEY, LINDA ANN (MS,LDN,RD)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:ANN
Last Name:MASSEY
Suffix:
Gender:F
Credentials:MS,LDN,RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 CALYPSO ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7506
Mailing Address - Country:US
Mailing Address - Phone:318-327-1900
Mailing Address - Fax:318-327-1901
Practice Address - Street 1:411 CALYPSO ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7506
Practice Address - Country:US
Practice Address - Phone:318-327-1900
Practice Address - Fax:318-327-1901
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA545133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered