Provider Demographics
NPI:1043875040
Name:MEZA, ABIGAIL LOUISA (RD, LD)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:LOUISA
Last Name:MEZA
Suffix:
Gender:
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 ARMORY ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:63645-1341
Mailing Address - Country:US
Mailing Address - Phone:573-846-8451
Mailing Address - Fax:573-783-8039
Practice Address - Street 1:105 ARMORY ST
Practice Address - Street 2:
Practice Address - City:FREDERICKTOWN
Practice Address - State:MO
Practice Address - Zip Code:63645-1341
Practice Address - Country:US
Practice Address - Phone:573-846-8451
Practice Address - Fax:573-783-8039
Is Sole Proprietor?:No
Enumeration Date:2019-05-06
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018043007133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered