Provider Demographics
NPI:1821377474
Name:OGBURN, ALISSA LYNN (RD)
Entity Type:Individual
Prefix:MRS
First Name:ALISSA
Middle Name:LYNN
Last Name:OGBURN
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 1:6316 N PLUM ST
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-4845
Mailing Address - Country:US
Mailing Address - Phone:620-664-3749
Mailing Address - Fax:
Practice Address - Street 1:6316 N PLUM ST
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-4845
Practice Address - Country:US
Practice Address - Phone:620-664-3749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-14
Last Update Date:2011-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1678133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered