Provider Demographics
NPI:1558023481
Name:CONLEY, ERIKA LOUISE (RD)
Entity type:Individual
Prefix:MS
First Name:ERIKA
Middle Name:LOUISE
Last Name:CONLEY
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 1:719 N COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-3922
Mailing Address - Country:US
Mailing Address - Phone:203-908-5545
Mailing Address - Fax:
Practice Address - Street 1:1905 CHERRY HILL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-5920
Practice Address - Country:US
Practice Address - Phone:573-343-4017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86278107133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA86278107OtherCDR
MO2023000385OtherMISSOURI DIVISION OF PROFESSIONAL REGISTRATION