Provider Demographics
NPI:1558327494
Name:PURVIS, KAREN ELAINE (LDN, RD)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:ELAINE
Last Name:PURVIS
Suffix:
Gender:F
Credentials:LDN, RD
Other - Prefix:MISS
Other - First Name:KAREN
Other - Middle Name:ELAINE
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2668
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404-2668
Mailing Address - Country:US
Mailing Address - Phone:985-230-6772
Mailing Address - Fax:985-230-6534
Practice Address - Street 1:15790 PAUL VEGA MD DR
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1434
Practice Address - Country:US
Practice Address - Phone:985-230-6772
Practice Address - Fax:985-230-6534
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1297133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
4C188Medicare ID - Type Unspecified