Virginia Boles, MS, RDN, LD, NBC-HWC
Individual provider Active NPI Registered Dietitian · Pearl, MS
NPI 1124612247 · NPPES record last updated Mar 1, 2021
Key facts
- NPI
- 1124612247
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Dietitian 133V00000X
- License
- D-1811 (MS)
- Practice address
- 3628 Longstreet Dr
Pearl, MS 39208-3814 - Phone
- (601) 481-5727
- NPI assigned
- Mar 1, 2021
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D-1811 | MS | MD | Registered Dietitian |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | D-1811 | MS | Yes |
Addresses
Primary practice location
3628 Longstreet Dr
Pearl, MS 39208-3814
Mailing address
3628 Longstreet Dr
Pearl, MS 39208-3814
Phone (601) 481-5727
Other providers in Pearl, MS
- Richard Adam Bell
- Benemed Holdings, Inc.
- Alexandra Morris Benoit
- Laurel Bland
- Kimberly Renee Blumenberg
- Mary Virginia Bost
- Gregory Bozeman
- David E Bozone Jr.
- Brandon Physician Management LLC
- Louis J Breland
All providers in Pearl, MS · Registered Dietitian in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 1, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.