Provider Demographics
NPI:1326485046
Name:SPOOR, JILLIAN E (RD, LD)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:E
Last Name:SPOOR
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 1:1742 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-2943
Mailing Address - Country:US
Mailing Address - Phone:325-670-4342
Mailing Address - Fax:325-670-5310
Practice Address - Street 1:1742 HICKORY ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2943
Practice Address - Country:US
Practice Address - Phone:325-670-4342
Practice Address - Fax:325-670-5310
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT07646133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered