=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689583692
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNA L LARKIN RD, CDCES
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2026
-----------------------------------------------------
Last Update Date | 09/04/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 S 14TH ST
-----------------------------------------------------
City | HERRIN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62948-3631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-942-2171
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11851 MERGANSER ST
-----------------------------------------------------
City | CARBONDALE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62901-1569
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-924-3746
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | 164.005583
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------