Provider Demographics
NPI:1205025921
Name:BYRNES, JANE T (R D ,L D)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:T
Last Name:BYRNES
Suffix:
Gender:F
Credentials:R D ,L D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 S ROCK RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-5150
Mailing Address - Country:US
Mailing Address - Phone:316-682-7411
Mailing Address - Fax:316-689-6688
Practice Address - Street 1:1709 S ROCK RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-5150
Practice Address - Country:US
Practice Address - Phone:316-682-7411
Practice Address - Fax:316-689-6688
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS655883133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS101639OtherMEDICARE PROVIDER #