Healthcare Provider Details

I. General information

NPI: 1689236085
Provider Name (Legal Business Name): LINDSEY JOY GELBER RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2019
Last Update Date: 05/27/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 S NATIONAL AVE
SPRINGFIELD MO
65807-7310
US

IV. Provider business mailing address

3535 S NATIONAL AVE
SPRINGFIELD MO
65807-7310
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-9767
  • Fax:
Mailing address:
  • Phone: 417-269-9767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2016026245
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: