Provider Demographics
NPI:1225581812
Name:SCHRADER, JOHANNAH (RD, LD, CDCES)
Entity Type:Individual
Prefix:
First Name:JOHANNAH
Middle Name:
Last Name:SCHRADER
Suffix:
Gender:F
Credentials:RD, LD, CDCES
Other - Prefix:
Other - First Name:JOHANNAH
Other - Middle Name:A
Other - Last Name:O'MALLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14919 PLATTSBURG RD
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:MO
Mailing Address - Zip Code:64060-8155
Mailing Address - Country:US
Mailing Address - Phone:207-838-5549
Mailing Address - Fax:
Practice Address - Street 1:14919 PLATTSBURG RD
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:MO
Practice Address - Zip Code:64060-8155
Practice Address - Country:US
Practice Address - Phone:207-838-5549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-29
Last Update Date:2023-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021002909133VN1006X, 133VN1201X, 133VN1501X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management
No133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics