Individual
ZACK KIDD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RD
Contact information
Practice address
510 E STONER AVE, SHREVEPORT, LA 71101-4243
(318) 990-4084
Mailing address
886 OAK GROVE CHURCH RD, GIBSLAND, LA 71028-4594
(940) 255-9249
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
886
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
727068
AMERICAN DIETETIC ASSOCIATION
LA
01
—
886
LOUISIANA DIETETIC ASSOCIATION
LA
Enumeration date
08/26/2013
Last updated
08/26/2013
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