Healthcare Provider Details

I. General information

NPI: 1982111464
Provider Name (Legal Business Name): DIABETES AND NUTRITION CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2018
Last Update Date: 01/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

267 CARMEL WOODS DR
ELLISVILLE MO
63021-4715
US

IV. Provider business mailing address

15455 MANCHESTER RD UNIT 13
BALLWIN MO
63022-5002
US

V. Phone/Fax

Practice location:
  • Phone: 337-207-9343
  • Fax: 337-207-9343
Mailing address:
  • Phone: 337-207-9343
  • Fax: 866-438-4042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number2017035075
License Number StateMO

VIII. Authorized Official

Name: MELISSA LYNN ARMATTA
Title or Position: SOLE PROPRIETOR
Credential: LD,RD,CDE
Phone: 337-207-9343