Cindy Jean Andrews Wallace, R.D., L.D.N., M.B.A

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

601842 Issued in LA

Practice address

3022 Old Minden Rd
Bossier City, LA 71112-2477

Phone

(318) 741-7314

Fax

(318) 741-7441

NPI assigned

Jul 30, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Business Administration

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1343606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343606400000",
    "number": "1497001333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "352 MERRITT RD",
            "city": "BENTON",
            "state": "LA",
            "postal_code": "710064319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3022 OLD MINDEN RD",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711122477",
            "telephone_number": "318-741-7314",
            "fax_number": "318-741-7441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "CINDY JEAN",
        "middle_name": "ANDREWS",
        "credential": "R.D., L.D.N., M.B.A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-30",
        "last_updated": "2012-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133N00000X",
            "taxonomy_group": "",
            "desc": "Nutritionist",
            "state": "LA",
            "license": "601842",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "LA",
            "license": "601842",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co (Walgreens #07004)
• Walgreen Co. (Walgreens #21523)
• Ashley Walker, PHARM.D.
• Shytrinity Jett Walker, RN
• Casey Anne Wall, PHARM. D.
• Lauren Marie Wallace, PA-C
• Nicholas Preston Wallace, LPC, NCC, CCMHC
• Sadie Noelle Wallace
• Tarkisha Wallace, LPC-S, NCC
• Kelsey Walraven

• Registered Dietitian in Bossier City, LA
• Providers in Bossier City, LA by specialty
• Registered Dietitian in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.