Provider Demographics
NPI:1770524126
Name:ARMATTA, MELISSA L (RD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:L
Last Name:ARMATTA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:MISSY
Other - Middle Name:
Other - Last Name:ARMATTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LDN,RD,CDE,CIPT
Mailing Address - Street 1:267 CARMEL WOODS DR
Mailing Address - Street 2:
Mailing Address - City:ELLISVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63021-4715
Mailing Address - Country:US
Mailing Address - Phone:337-207-9343
Mailing Address - Fax:866-438-4042
Practice Address - Street 1:1025 S 6TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-2403
Practice Address - Country:US
Practice Address - Phone:217-528-7541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1008133V00000X
IL164007494133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4H8627477Medicare PIN