Provider Demographics
NPI:1376123323
Name:POE, JANEA LOUISE (RD)
Entity Type:Individual
Prefix:
First Name:JANEA
Middle Name:LOUISE
Last Name:POE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28081 S SHAWNEE HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:QUENEMO
Mailing Address - State:KS
Mailing Address - Zip Code:66528-8009
Mailing Address - Country:US
Mailing Address - Phone:816-213-1514
Mailing Address - Fax:
Practice Address - Street 1:421 S MAPLE ST
Practice Address - Street 2:
Practice Address - City:GARNETT
Practice Address - State:KS
Practice Address - Zip Code:66032-1334
Practice Address - Country:US
Practice Address - Phone:816-213-1514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1056133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1056OtherKS LICENSURE