Provider Demographics
NPI:1073958955
Name:JOYNER, NICOLE GWEN (MA, RDN, LD)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:GWEN
Last Name:JOYNER
Suffix:
Gender:F
Credentials:MA, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13550 W 63RD ST
Mailing Address - Street 2:HY-VEE, INC.
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66216-3814
Mailing Address - Country:US
Mailing Address - Phone:913-962-2252
Mailing Address - Fax:913-962-2369
Practice Address - Street 1:13550 W 63RD ST
Practice Address - Street 2:HY-VEE, INC.
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66216-3814
Practice Address - Country:US
Practice Address - Phone:913-962-2252
Practice Address - Fax:913-962-2369
Is Sole Proprietor?:No
Enumeration Date:2013-05-06
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2093133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered