Provider Demographics
NPI:1326510009
Name:FITZWATER, JODELLE (NTP)
Entity Type:Individual
Prefix:
First Name:JODELLE
Middle Name:
Last Name:FITZWATER
Suffix:
Gender:F
Credentials:NTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 581
Mailing Address - Street 2:
Mailing Address - City:KIMBERLING CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65686-0581
Mailing Address - Country:US
Mailing Address - Phone:417-230-0554
Mailing Address - Fax:
Practice Address - Street 1:422 CASTLE ROCK ROAD
Practice Address - Street 2:
Practice Address - City:REEDS SPRING
Practice Address - State:MO
Practice Address - Zip Code:65737
Practice Address - Country:US
Practice Address - Phone:417-230-0554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education