Provider Demographics
NPI:1013238708
Name:WATSON, KODI LEE (MS, RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:KODI
Middle Name:LEE
Last Name:WATSON
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:KODI
Other - Middle Name:LEE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, LD
Mailing Address - Street 1:8301 N ST. CLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151
Mailing Address - Country:US
Mailing Address - Phone:816-505-1000
Mailing Address - Fax:816-505-1026
Practice Address - Street 1:8301 N ST. CLAIR AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151
Practice Address - Country:US
Practice Address - Phone:816-505-1000
Practice Address - Fax:816-505-1026
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010018311133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA2496002Medicare UPIN