Provider Demographics
NPI:1770025371
Name:ERICKSON, KENDRA ROVELLO (RDN, LD)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:ROVELLO
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4813 W 121ST ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-1586
Mailing Address - Country:US
Mailing Address - Phone:913-314-8765
Mailing Address - Fax:
Practice Address - Street 1:421 S MAPLE ST
Practice Address - Street 2:
Practice Address - City:GARNETT
Practice Address - State:KS
Practice Address - Zip Code:66032-1334
Practice Address - Country:US
Practice Address - Phone:913-314-8765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2042133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered