Provider Demographics
NPI:1588737464
Name:MORRIS, WHITNEY LEO JR (RD)
Entity type:Individual
Prefix:MR
First Name:WHITNEY
Middle Name:LEO
Last Name:MORRIS
Suffix:JR
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:826 SW AMBERWOOD LOOP
Mailing Address - Street 2:APARTMENT # 102
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-6979
Mailing Address - Country:US
Mailing Address - Phone:504-452-2168
Mailing Address - Fax:
Practice Address - Street 1:619 S MARION AVE
Practice Address - Street 2:NUTRITION AND FOOD SERVICE (120)
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-5808
Practice Address - Country:US
Practice Address - Phone:386-755-3016
Practice Address - Fax:386-745-6312
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL916707133V00000X
916707136A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered