Provider Demographics
NPI:1811753841
Name:FITZPATRICK, JACEY BUSBICE (RD, LDN)
Entity type:Individual
Prefix:MRS
First Name:JACEY
Middle Name:BUSBICE
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6460 HIGHWAY 37
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:LA
Mailing Address - Zip Code:70441-3350
Mailing Address - Country:US
Mailing Address - Phone:985-498-9305
Mailing Address - Fax:
Practice Address - Street 1:59656 PULESTON RD
Practice Address - Street 2:
Practice Address - City:AMITE
Practice Address - State:LA
Practice Address - Zip Code:70422-5616
Practice Address - Country:US
Practice Address - Phone:985-748-2538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2938133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered