Provider Demographics
NPI:1376724351
Name:BARBER, JILL ELIZABETH (RD LD)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:ELIZABETH
Last Name:BARBER
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:MS
Other - First Name:JILL
Other - Middle Name:ELIZABETH
Other - Last Name:SCHREMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD LD
Mailing Address - Street 1:7 N OAK ST
Mailing Address - Street 2:
Mailing Address - City:PERRYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63775-2732
Mailing Address - Country:US
Mailing Address - Phone:573-823-4535
Mailing Address - Fax:
Practice Address - Street 1:3095 LEXINGTON AVE STE 200
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-2629
Practice Address - Country:US
Practice Address - Phone:573-803-4060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007033150133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2007033150OtherMISSOURI LICENSE