Provider Demographics
NPI:1619292141
Name:BALL, JILLIAN (RD, CDE, LD)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:BALL
Suffix:
Gender:F
Credentials:RD, CDE, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 S 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-7706
Mailing Address - Country:US
Mailing Address - Phone:417-230-1656
Mailing Address - Fax:417-230-1656
Practice Address - Street 1:732 N 22ND ST
Practice Address - Street 2:SUITE 107
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-8662
Practice Address - Country:US
Practice Address - Phone:417-230-1656
Practice Address - Fax:417-230-1656
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-27
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004036689133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered