Individual
MRS. VICKI M BLACKWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS,LDN,RD
Contact information
Practice address
510 E STONER AVE, SHREVEPORT, LA 71101-4243
(318) 221-8411
Mailing address
208 RIDGEFIELD DR, BOSSIER CITY, LA 71111-2369
(318) 747-7856
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
363
LA
Other
Enumeration date
03/14/2006
Last updated
07/16/2007
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