Provider Demographics
NPI:1013356054
Name:BENNETT, REBECCA (RD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:BENNETT
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 1:8550 MARSHALL DR STE 220
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66214-1505
Mailing Address - Country:US
Mailing Address - Phone:816-276-6200
Mailing Address - Fax:913-495-3720
Practice Address - Street 1:2340 E MEYER BLVD STE 642
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64132-1110
Practice Address - Country:US
Practice Address - Phone:816-276-6200
Practice Address - Fax:913-495-3720
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-24
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1846133V00000X
MO2008024148133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2008024148OtherMISSOURI LICENSE