| Doctor Name: | MR. JAMES KEVIN GILLIGAN |
| NPI Number: | 1629453097 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | RD, LD |
| License Number: | 2012036779 |
| Business Practice Address: | 501 Lake Land Blvd Mattoon, IL - 619385283 |
| Business Phone Number: | 2172583370 |
| Business Fax Number: | |
| Mailing Address: | 6612 Winnebago St, SAINT LOUIS |
| State: | MO |
| Postal Code: | 631091245 |
| Phone Number: | 3145370932 |
| Fax Number: | |
| NPI Enumeration Date: | 07/27/2015 |
| NPI Last Update Date: | 07/27/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133V00000X |
| License Number: | 2012036779 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MO |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |