Healthcare Provider Details

I. General information

NPI: 1649953316
Provider Name (Legal Business Name): HOLLEY DROCHELMAN MS, RDN, LD, CEDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2023
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

584 MEADOWRIDGE DR
SAINT LOUIS MO
63122-3016
US

IV. Provider business mailing address

10786 INDIAN HEAD INDUSTRIAL BLVD # 1149
SAINT LOUIS MO
63132-1102
US

V. Phone/Fax

Practice location:
  • Phone: 314-266-1502
  • Fax:
Mailing address:
  • Phone: 314-266-1502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2020034564
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: