Provider Demographics
NPI:1659718179
Name:HARTLEY, ADRIENNE (RD, LD)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:
Last Name:HARTLEY
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 1:207 NE ENGLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64118-4586
Mailing Address - Country:US
Mailing Address - Phone:816-454-4776
Mailing Address - Fax:
Practice Address - Street 1:207 NE ENGLEWOOD RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64118-4586
Practice Address - Country:US
Practice Address - Phone:816-454-4776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-23
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007038089133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered