Provider Demographics
NPI:1558806000
Name:WARREN, JOCELYN (RD, LD, CNSC)
Entity Type:Individual
Prefix:MRS
First Name:JOCELYN
Middle Name:
Last Name:WARREN
Suffix:
Gender:F
Credentials:RD, LD, CNSC
Other - Prefix:
Other - First Name:JOCELYN
Other - Middle Name:
Other - Last Name:WOMBLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, CD, CNSC
Mailing Address - Street 1:12495 HIGHWAY T
Mailing Address - Street 2:
Mailing Address - City:MARIONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65705-7121
Mailing Address - Country:US
Mailing Address - Phone:417-880-4187
Mailing Address - Fax:
Practice Address - Street 1:12495 HIGHWAY T
Practice Address - Street 2:
Practice Address - City:MARIONVILLE
Practice Address - State:MO
Practice Address - Zip Code:65705-7121
Practice Address - Country:US
Practice Address - Phone:417-880-4187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-19
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60694929133V00000X
MO2018010193133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered