Provider Demographics
NPI:1891491452
Name:HAMMON, EMILY ELIZABETH (RD LD N)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:ELIZABETH
Last Name:HAMMON
Suffix:
Gender:F
Credentials:RD LD N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2773 WHITECREEK LN
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:MO
Mailing Address - Zip Code:63052-4358
Mailing Address - Country:US
Mailing Address - Phone:314-223-4647
Mailing Address - Fax:
Practice Address - Street 1:2773 WHITECREEK LN
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:MO
Practice Address - Zip Code:63052-4358
Practice Address - Country:US
Practice Address - Phone:314-223-4647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.005050133V00000X
MO2004034303133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered