Provider Demographics
NPI:1669518007
Name:LOUDERMILK-COLLINS, SHERRY ANN (RD)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:ANN
Last Name:LOUDERMILK-COLLINS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:ANN
Other - Last Name:RUPARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:9521 NE 779 RD
Mailing Address - Street 2:
Mailing Address - City:LOWRY CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64763-8179
Mailing Address - Country:US
Mailing Address - Phone:660-890-7096
Mailing Address - Fax:
Practice Address - Street 1:1600 N 2ND ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MO
Practice Address - Zip Code:64735-1192
Practice Address - Country:US
Practice Address - Phone:660-885-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001012668133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO355172107Medicaid
MO355172107Medicaid