Individual
TABITHA NICHOLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., RD, LDN
Contact information
Practice address
114 STATE ST, LAKE CHARLES, LA 70605-5718
(337) 419-0942
(337) 314-1243
Mailing address
3201 FLATWOOD DR, LAKE CHARLES, LA 70607-4324
(337) 419-0942
(337) 314-1243
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
2038
LA
133V00000X
Registered Dietitian
Primary
2038
LA
133VN1005X
Renal Nutrition Registered Dietitian
2038
LA
Other
Enumeration date
05/24/2010
Last updated
11/11/2021
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