Provider Demographics
NPI:1073830600
Name:ADAMS, REBECCA (RD/ LD)
Entity Type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:RD/ LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 VISTA HILLS CT
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025-3605
Mailing Address - Country:US
Mailing Address - Phone:636-221-8414
Mailing Address - Fax:
Practice Address - Street 1:140 PROSPECT AVE STE M
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-6074
Practice Address - Country:US
Practice Address - Phone:636-686-0682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-21
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009022580133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered