Provider Demographics
NPI:1275149841
Name:STAGNER, KENDALL (RD)
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:
Last Name:STAGNER
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MARTIN DR
Mailing Address - Street 2:
Mailing Address - City:AGENCY
Mailing Address - State:MO
Mailing Address - Zip Code:64401-9110
Mailing Address - Country:US
Mailing Address - Phone:816-244-7850
Mailing Address - Fax:
Practice Address - Street 1:1 MARTIN DR
Practice Address - Street 2:
Practice Address - City:AGENCY
Practice Address - State:MO
Practice Address - Zip Code:64401-9110
Practice Address - Country:US
Practice Address - Phone:816-244-7850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-19
Last Update Date:2020-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered