Healthcare Provider Details

I. General information

NPI: 1386140317
Provider Name (Legal Business Name): TAYLOR C JOLLIFF MS, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAYLOR C NOLL RD

II. Dates (important events)

Enumeration Date: 03/30/2018
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 E BRADFORD PKWY BLDG B
SPRINGFIELD MO
65804-4294
US

IV. Provider business mailing address

2885 W BATTLEFIELD ST
SPRINGFIELD MO
65807-3952
US

V. Phone/Fax

Practice location:
  • Phone: 417-761-5000
  • Fax: 417-761-5011
Mailing address:
  • Phone: 417-761-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2018008577
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: