Provider Demographics
NPI:1265007108
Name:JONES, MEGAN (RD, LD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:JONES
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 1:12266 DEPAUL DRIVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2529
Mailing Address - Country:US
Mailing Address - Phone:314-344-6800
Mailing Address - Fax:314-344-6801
Practice Address - Street 1:12266 DEPAUL DRIVE
Practice Address - Street 2:SUITE 210
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2529
Practice Address - Country:US
Practice Address - Phone:314-344-6800
Practice Address - Fax:314-344-6801
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO86078125133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered