MEDICARE: MS. ADRIENNE FRANTONIO JEFFERSON 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
1	133V00000X	Registered Dietitian	DT05838	TX

General Provider Information

NPI Number	:	1932323631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ADRIENNE FRANTONIO JEFFERSON RD, LD

Provider Business Mailing Address
First Line	:	20 S SARAH ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-2819
Country	:	US
Telephone Number	:	844-473-2455
Fax Number	:	646-844-6979

Provider Business Practice Location Address
First Line	:	1601 ELM ST STE 4360
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75201-4701
Country	:	US
Telephone Number	:	844-473-2455
Fax Number	:	646-844-6979

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	04/17/2020

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