Healthcare Provider Details

I. General information

NPI: 1558699942
Provider Name (Legal Business Name): LISA LYN JONES RD,LD, CBE, CSOWM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2009
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 HUEBNER RD
FORT RILEY KS
66442-4030
US

IV. Provider business mailing address

600 CAISSON HILL RD
FORT RILEY KS
66442-7037
US

V. Phone/Fax

Practice location:
  • Phone: 785-239-7644
  • Fax:
Mailing address:
  • Phone: 785-239-7644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1308
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: