Provider Demographics
NPI:1194335141
Name:WILMOT, TARA (RDN, LD)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:WILMOT
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:YARNALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12835 STRATHEARN DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-3755
Mailing Address - Country:US
Mailing Address - Phone:314-956-1438
Mailing Address - Fax:
Practice Address - Street 1:660 S EUCLID AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1010
Practice Address - Country:US
Practice Address - Phone:314-362-8703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008027344133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered