Provider Demographics
NPI:1760364731
Name:VEDROS, KATIE (RDN)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:VEDROS
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:BONVILLAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5215 ESSEN LN STE 200
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3543
Mailing Address - Country:US
Mailing Address - Phone:225-215-1281
Mailing Address - Fax:225-215-1380
Practice Address - Street 1:2800 VETERANS MEMORIAL BLVD STE 140
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-6139
Practice Address - Country:US
Practice Address - Phone:504-584-6990
Practice Address - Fax:504-584-6980
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3184133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered