Healthcare Provider Details

I. General information

NPI: 1477324663
Provider Name (Legal Business Name): TREY ALLEN VUICHARD MS, RD, LD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2024
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 HOSPITAL DR
HANNIBAL MO
63401-6887
US

IV. Provider business mailing address

6000 HOSPITAL DR
HANNIBAL MO
63401-6887
US

V. Phone/Fax

Practice location:
  • Phone: 573-406-5907
  • Fax:
Mailing address:
  • Phone: 573-406-5907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2021041789
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: