Healthcare Provider Details

I. General information

NPI: 1215867106
Provider Name (Legal Business Name): LISA TIGGES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 S EUCLID AVE
SAINT LOUIS MO
63110-1010
US

IV. Provider business mailing address

3816 JUNIATA ST
SAINT LOUIS MO
63116-4814
US

V. Phone/Fax

Practice location:
  • Phone: 314-957-8222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2015038444
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: