Provider Demographics
NPI:1659512424
Name:JARRELL, ADRIENNE LOUISE (MS, RD, LDN, CDCES)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:LOUISE
Last Name:JARRELL
Suffix:
Gender:F
Credentials:MS, RD, LDN, CDCES
Other - Prefix:
Other - First Name:ADRIENNE
Other - Middle Name:LOUISE
Other - Last Name:SILENCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2736 KIMWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:IL
Mailing Address - Zip Code:61920-4311
Mailing Address - Country:US
Mailing Address - Phone:217-508-4244
Mailing Address - Fax:
Practice Address - Street 1:500 N MAPLE ST STE 200
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-2001
Practice Address - Country:US
Practice Address - Phone:217-787-8870
Practice Address - Fax:217-347-6698
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-09
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164003464133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered