Provider Demographics
NPI:1073014676
Name:AVERSMAN, SONYA RENEE (RD)
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:RENEE
Last Name:AVERSMAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:SONYA
Other - Middle Name:RENEE
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:8909 S HARDSAW RD
Mailing Address - Street 2:
Mailing Address - City:LONE JACK
Mailing Address - State:MO
Mailing Address - Zip Code:64070
Mailing Address - Country:US
Mailing Address - Phone:816-679-0186
Mailing Address - Fax:
Practice Address - Street 1:3680 NE AKIN DR
Practice Address - Street 2:SUITE 134
Practice Address - City:LEE'S SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064
Practice Address - Country:US
Practice Address - Phone:816-679-0186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011013518133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered