Provider Demographics
NPI:1649978008
Name:BEGGS, MICHAELA JADE (RDN)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:JADE
Last Name:BEGGS
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:MICHAELA
Other - Middle Name:JADE
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:7408 222ND AVENUE CT E
Mailing Address - Street 2:
Mailing Address - City:BUCKLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98321-7448
Mailing Address - Country:US
Mailing Address - Phone:253-249-4205
Mailing Address - Fax:
Practice Address - Street 1:3560 BRIDGEPORT WAY W
Practice Address - Street 2:SUITE A
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466
Practice Address - Country:US
Practice Address - Phone:253-343-6050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-15
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
WADI61405696133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered