Provider Demographics
NPI:1700280047
Name:RATH, KIM
Entity type:Individual
Prefix:MRS
First Name:KIM
Middle Name:
Last Name:RATH
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:CRAFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:17107 PLATTSBURG RD
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:MO
Mailing Address - Zip Code:64060-8387
Mailing Address - Country:US
Mailing Address - Phone:816-628-3310
Mailing Address - Fax:
Practice Address - Street 1:3027 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64128-1530
Practice Address - Country:US
Practice Address - Phone:816-861-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011023312133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered