Provider Demographics
NPI:1255152203
Name:FRAVEL, EMILY (RD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:FRAVEL
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 1:10804 W 70TH TER
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66203-4128
Mailing Address - Country:US
Mailing Address - Phone:913-237-4605
Mailing Address - Fax:
Practice Address - Street 1:11100 ASH ST STE 110
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1700
Practice Address - Country:US
Practice Address - Phone:913-237-4605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2881133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered