Healthcare Provider Details

I. General information

NPI: 1720925464
Provider Name (Legal Business Name): NANCY E TRAIL RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NANCY E FISHER

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 OLD SOUTH RIVER RD
SAINT CHARLES MO
63303-4120
US

IV. Provider business mailing address

PO BOX 844715
KANSAS CITY MO
64184-4715
US

V. Phone/Fax

Practice location:
  • Phone: 636-224-1202
  • Fax: 636-946-0971
Mailing address:
  • Phone: 417-761-5214
  • Fax: 417-761-5065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2008020826
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: