Provider Demographics
NPI:1750065553
Name:GILKEY, JESSICA (RD, LD/N)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:GILKEY
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 1:1422 JUANITA DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:MO
Mailing Address - Zip Code:65712-1909
Mailing Address - Country:US
Mailing Address - Phone:636-288-0700
Mailing Address - Fax:
Practice Address - Street 1:1000 E HIGHWAY 60
Practice Address - Street 2:
Practice Address - City:MONETT
Practice Address - State:MO
Practice Address - Zip Code:65708-1698
Practice Address - Country:US
Practice Address - Phone:417-236-2591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND7089133V00000X
MO2023020960133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered