Provider Demographics
NPI:1407426851
Name:WYANT, MEGAN NICOLE
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:NICOLE
Last Name:WYANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 GRAND BLVD UNIT 1406
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64106-2632
Mailing Address - Country:US
Mailing Address - Phone:660-635-1345
Mailing Address - Fax:
Practice Address - Street 1:1125 GRAND BLVD UNIT 1406
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64106-2632
Practice Address - Country:US
Practice Address - Phone:660-635-1345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013021251133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered