Provider Demographics
NPI:1699972190
Name:KNIGHT, MARY ELIZABETH T (RD, LDN)
Entity type:Individual
Prefix:MRS
First Name:MARY ELIZABETH
Middle Name:T
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:MRS
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:KNIGHT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD LDN
Mailing Address - Street 1:48117 HIGHWAY 16
Mailing Address - Street 2:
Mailing Address - City:FRANKLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70438-4109
Mailing Address - Country:US
Mailing Address - Phone:985-730-6895
Mailing Address - Fax:
Practice Address - Street 1:433 PLAZA ST
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-3729
Practice Address - Country:US
Practice Address - Phone:985-730-6895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA258133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA258OtherLDA LICENSE
LA4H1637495Medicare ID - Type Unspecified