Provider Demographics
NPI:1750267159
Name:THOMPSON, KELLY FRAZIER (RD, LDN)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:FRAZIER
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1656 HODGES ST
Mailing Address - Street 2:
Mailing Address - City:JENA
Mailing Address - State:LA
Mailing Address - Zip Code:71342-4312
Mailing Address - Country:US
Mailing Address - Phone:318-229-5486
Mailing Address - Fax:
Practice Address - Street 1:1656 HODGES ST
Practice Address - Street 2:
Practice Address - City:JENA
Practice Address - State:LA
Practice Address - Zip Code:71342-4312
Practice Address - Country:US
Practice Address - Phone:318-229-5486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD007556133V00000X
FLND14069133V00000X
LA1252133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered