Provider Demographics
NPI:1689931214
Name:ANDERSON, ELIZABETH ASHLEY (MS, RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ASHLEY
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:FUGITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5830 NW BARRY RD
Mailing Address - Street 2:DIABETES SELF MANAGEMENT PROGRAM
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64154-2778
Mailing Address - Country:US
Mailing Address - Phone:816-880-6742
Mailing Address - Fax:
Practice Address - Street 1:5830 NW BARRY RD
Practice Address - Street 2:DIABETES SELF MANAGEMENT PROGRAM
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64154-2778
Practice Address - Country:US
Practice Address - Phone:816-880-6742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012006800133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered