Provider Demographics
NPI:1659731271
Name:SCHROCK, KELLY (RD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:SCHROCK
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2790 CLAY EDWARDS DR STE 1250
Mailing Address - Street 2:C/O HELLMAN & ROSEN ENDOCRINE
Mailing Address - City:NORTH KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3260
Mailing Address - Country:US
Mailing Address - Phone:816-421-3700
Mailing Address - Fax:816-421-1654
Practice Address - Street 1:2790 CLAY EDWARDS DR STE 1250
Practice Address - Street 2:C/O HELLMAN & ROSEN ENDOCRINE
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3260
Practice Address - Country:US
Practice Address - Phone:816-421-3700
Practice Address - Fax:816-421-1654
Is Sole Proprietor?:No
Enumeration Date:2016-02-24
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO402000025Medicare PIN