Provider Demographics
NPI:1265217731
Name:ROTHWELL, MELISSA (RD, LD)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:ROTHWELL
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:PORTLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4800 MCCORMICK DR
Mailing Address - Street 2:
Mailing Address - City:BASEHOR
Mailing Address - State:KS
Mailing Address - Zip Code:66007-9761
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23401 PRAIRIE STAR PKWY
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66227-7268
Practice Address - Country:US
Practice Address - Phone:913-356-6417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2227133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered