Provider Demographics
NPI:1649601683
Name:SHINKLE, RACHAEL JEAN (RD LD CDE)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:JEAN
Last Name:SHINKLE
Suffix:
Gender:F
Credentials:RD LD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8220 ELK RD
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:KS
Mailing Address - Zip Code:66736-7460
Mailing Address - Country:US
Mailing Address - Phone:620-288-0774
Mailing Address - Fax:
Practice Address - Street 1:314 N 7TH ST
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:KS
Practice Address - Zip Code:66736-1337
Practice Address - Country:US
Practice Address - Phone:620-288-0774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-02
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1832133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered