Provider Demographics
NPI:1518298470
Name:HEIDARI, ABBY MARIE (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:ABBY
Middle Name:MARIE
Last Name:HEIDARI
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 1:12200 STATE LINE RD.
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66204
Mailing Address - Country:US
Mailing Address - Phone:913-345-9477
Mailing Address - Fax:913-345-0957
Practice Address - Street 1:12200 STATE LINE RD
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66209-1217
Practice Address - Country:US
Practice Address - Phone:913-345-9477
Practice Address - Fax:913-345-0957
Is Sole Proprietor?:No
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS85007357133V00000X
MO85007357133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered