Provider Demographics
NPI:1417388133
Name:FRAZIER, BETHANY (RD, LD)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:FRAZIER
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 1:6240 W 156TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-3621
Mailing Address - Country:US
Mailing Address - Phone:816-695-8245
Mailing Address - Fax:
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:
Is Sole Proprietor?:No
Enumeration Date:2013-12-05
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1879133V00000X
MO2013042149133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
1417388133OtherNPI