Provider Demographics
NPI:1780867085
Name:NELSON, ANNIE MARIE (RD)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:MARIE
Last Name:NELSON
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 1:10604 WALROND AVE
Mailing Address - Street 2:PO BOX 46213
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64137-1755
Mailing Address - Country:US
Mailing Address - Phone:816-966-0924
Mailing Address - Fax:
Practice Address - Street 1:1610 SOUTHRIDGE DR
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65102-9743
Practice Address - Country:US
Practice Address - Phone:573-751-6303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001025280133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered