Individual
NICOLE DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RDN, LDN
Contact information
Practice address
350 ZACH LN, OZARK, IL 62972-1119
(618) 889-9570
Mailing address
350 ZACH LN, OZARK, IL 62972-1119
(618) 889-9570
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
164.006153
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1065198
COMMISSION ON DIETETIC REGISTRATION
—
Enumeration date
06/25/2015
Last updated
02/04/2026
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