Provider Demographics
NPI:1457167363
Name:EARLES, BOBBIE JO (MBA, RDN)
Entity type:Individual
Prefix:
First Name:BOBBIE
Middle Name:JO
Last Name:EARLES
Suffix:
Gender:F
Credentials:MBA, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9178 CUT BANK WAY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908-2708
Mailing Address - Country:US
Mailing Address - Phone:405-245-7269
Mailing Address - Fax:
Practice Address - Street 1:9178 CUT BANK WAY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80908-2708
Practice Address - Country:US
Practice Address - Phone:405-245-7269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86370896133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered