Provider Demographics
NPI:1295604163
Name:BAAN, MCKENNA NICOLE (RD,LD)
Entity type:Individual
Prefix:
First Name:MCKENNA
Middle Name:NICOLE
Last Name:BAAN
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4520 EMERALD VIEW CT
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025-2374
Mailing Address - Country:US
Mailing Address - Phone:636-730-8690
Mailing Address - Fax:
Practice Address - Street 1:4520 EMERALD VIEW CT
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MO
Practice Address - Zip Code:63025-2374
Practice Address - Country:US
Practice Address - Phone:636-730-8690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-30
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered