Individual
MRS. ALICE POWELL TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D.
Contact information
Practice address
ST. DOMINIC WEIGHT LOSS SOLUTIONS, 3800 INTERSTATE 55 NORTH FRONTAGE ROAD SUITE 102, JACKSON, MS 39211
(601) 200-6872
Mailing address
131 WOODLANDS GREEN DR, BRANDON, MS 39047-8773
(601) 954-5727
Taxonomy
Speciality
Code
Description
License number
State
133VN1201X
Obesity and Weight Management Nutrition Registered Dietitian
Primary
D0219
MS
133VN1301X
Oncology Nutrition Registered Dietitian
D0219
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
690960
COMMISSION ON DIETETIC REGISTRATION/ACADEMY OF NUTRITION AND DIETETICS
—
01
—
D0219
REGISTERED DIETITIAN LICENSE
MS
Enumeration date
01/24/2020
Last updated
01/24/2020
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