Healthcare Provider Details

I. General information

NPI: 1982953196
Provider Name (Legal Business Name): LYNN MARGARET EATON RD, LD, CDCES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LYNN MARGARET GRANT RD, LD

II. Dates (important events)

Enumeration Date: 09/04/2012
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 CHERRY HILL DR STE 300
COLUMBIA MO
65203-5812
US

IV. Provider business mailing address

1905 CHERRY HILL DR STE 300
COLUMBIA MO
65203-5812
US

V. Phone/Fax

Practice location:
  • Phone: 573-343-4017
  • Fax: 573-615-4443
Mailing address:
  • Phone: 573-343-4017
  • Fax: 573-615-4443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2012028920
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: