Provider Demographics
NPI:1457695793
Name:PAGE, BLAKELY ANN (RD, LD)
Entity Type:Individual
Prefix:
First Name:BLAKELY
Middle Name:ANN
Last Name:PAGE
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9901 W 70TH ST
Mailing Address - Street 2:
Mailing Address - City:MERRIAM
Mailing Address - State:KS
Mailing Address - Zip Code:66203-4211
Mailing Address - Country:US
Mailing Address - Phone:913-744-6872
Mailing Address - Fax:
Practice Address - Street 1:9901 W 70TH ST
Practice Address - Street 2:
Practice Address - City:MERRIAM
Practice Address - State:KS
Practice Address - Zip Code:66203-4211
Practice Address - Country:US
Practice Address - Phone:913-744-6872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1654133V00000X
MO2005037968133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered