Provider Demographics
NPI:1750977674
Name:BAUSTIAN, BETH (RD)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:BAUSTIAN
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 1:600 NE ADAMS DAIRY PKWY
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-5493
Mailing Address - Country:US
Mailing Address - Phone:816-347-5200
Mailing Address - Fax:816-347-5206
Practice Address - Street 1:600 NE ADAMS DAIRY PKWY
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-5493
Practice Address - Country:US
Practice Address - Phone:816-347-5200
Practice Address - Fax:816-347-5206
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-15
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2972133V00000X
IA86100401133V00000X
MO2023013895133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered