Provider Demographics
NPI:1598498453
Name:GREGG, ALEXANDRA MAE (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:MAE
Last Name:GREGG
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 1:8450 NW PR VW RD # 1441
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64153-1841
Mailing Address - Country:US
Mailing Address - Phone:507-990-4403
Mailing Address - Fax:507-322-1832
Practice Address - Street 1:2420 SW WINTERFIELD CT
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64081-4098
Practice Address - Country:US
Practice Address - Phone:816-875-0077
Practice Address - Fax:507-322-1832
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-07
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022025851133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered