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NPI Code Detail

MEDICARE: MRS. JILL ELIZABETH BARBER RD LD

MEDICARE: MRS. JILL ELIZABETH BARBER RD LD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian2007033150MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12007033150OTHERMOMISSOURI LICENSE

General Provider Information

NPI Number : 1376724351
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JILL ELIZABETH BARBER RD LD
Provider Business Mailing Address
First Line : 7 N OAK ST
Second Line :
City : PERRYVILLE
State : MO
Zip : 63775-2732
Country : US
Telephone Number : 573-823-4535
Fax Number :
Provider Business Practice Location Address
First Line : 3095 LEXINGTON AVE STE 200
Second Line :
City : CAPE GIRARDEAU
State : MO
Zip : 63701-2629
Country : US
Telephone Number : 573-803-4060
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/19/2007
Last Update Date : 05/27/2022

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