Provider Demographics
NPI:1427928175
Name:FRIESS, TRICIA RENEE (RD)
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:RENEE
Last Name:FRIESS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10554 US HIGHWAY 61
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-7170
Mailing Address - Country:US
Mailing Address - Phone:573-576-2503
Mailing Address - Fax:
Practice Address - Street 1:10554 US HIGHWAY 61
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755-7170
Practice Address - Country:US
Practice Address - Phone:573-576-2503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-07
Last Update Date:2025-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001021473133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered