Provider Demographics
NPI:1043534639
Name:COLE, MELODY A (RD)
Entity Type:Individual
Prefix:MRS
First Name:MELODY
Middle Name:A
Last Name:COLE
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 1:6801 W 91ST ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-1459
Mailing Address - Country:US
Mailing Address - Phone:913-385-2111
Mailing Address - Fax:913-648-1683
Practice Address - Street 1:6801 W 91ST ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-1459
Practice Address - Country:US
Practice Address - Phone:913-385-2111
Practice Address - Fax:913-648-1683
Is Sole Proprietor?:No
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1067133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered