Provider Demographics
NPI:1376190678
Name:KANSAS CITY DIETITIAN LLC
Entity Type:Organization
Organization Name:KANSAS CITY DIETITIAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LD
Authorized Official - Phone:816-695-8245
Mailing Address - Street 1:6801 W 121ST ST STE 121
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-2005
Mailing Address - Country:US
Mailing Address - Phone:816-695-8245
Mailing Address - Fax:844-692-5186
Practice Address - Street 1:6240 W 156TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223-3621
Practice Address - Country:US
Practice Address - Phone:816-695-8245
Practice Address - Fax:844-692-5186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-21
Last Update Date:2021-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1891101309OtherNPI
1417388133OtherNPI
1417203076OtherNPI
1043650609OtherNPI