Healthcare Provider Details

I. General information

NPI: 1871906149
Provider Name (Legal Business Name): MEGAN ELIZABETH JEFFRIS RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2014
Last Update Date: 07/02/2024
Certification Date:
Deactivation Date: 06/13/2024
Reactivation Date: 07/02/2024

III. Provider practice location address

2135 S FREMONT AVE
SPRINGFIELD MO
65804-2239
US

IV. Provider business mailing address

6600 VAN AALST BLVD
FORT MOORE GA
31905
US

V. Phone/Fax

Practice location:
  • Phone: 417-820-7990
  • Fax:
Mailing address:
  • Phone: 509-630-4005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2013025851
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number086345526
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: