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Organization

PROFESSIONAL NUTRITION SERVICES LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. LATOSHA WILDER YOUNG RD, LD (OWNER/MANAGER)
(662) 836-4450
Entity
Organization

Contact information

Practice address
301 LEE ST, BELZONI, MS 39038-3705
(662) 836-4450
Mailing address
301 LEE ST, BELZONI, MS 39038-3705
(662) 836-4450

Taxonomy

Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
D1613
MS
133V00000X
Registered Dietitian
Primary
D1613
MS

Other

Enumeration date
06/15/2017
Last updated
07/21/2022
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