Provider Demographics
NPI:1285303693
Name:CONRAD, AVA (MS, RDN, LDN)
Entity type:Individual
Prefix:
First Name:AVA
Middle Name:
Last Name:CONRAD
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 1:289 EAST DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-5105
Mailing Address - Country:US
Mailing Address - Phone:570-441-4966
Mailing Address - Fax:
Practice Address - Street 1:289 EAST DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-5105
Practice Address - Country:US
Practice Address - Phone:570-441-4966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-09
Last Update Date:2023-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX6234133V00000X
LA3217133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered