Provider Demographics
NPI:1740857192
Name:SKINNER, DENISE MICHELLE (RD)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:MICHELLE
Last Name:SKINNER
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 1:12322 W 55TH ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66216-1404
Mailing Address - Country:US
Mailing Address - Phone:913-645-0031
Mailing Address - Fax:
Practice Address - Street 1:12322 W 55TH ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66216-1404
Practice Address - Country:US
Practice Address - Phone:913-645-0031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020017999133V00000X
KS2492133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered