Provider Demographics
NPI:1841446150
Name:MARKLEY, LISA ANN (MS, RDN, LD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:MARKLEY
Suffix:
Gender:F
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7840 W 165TH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-3021
Mailing Address - Country:US
Mailing Address - Phone:913-632-3552
Mailing Address - Fax:913-632-3559
Practice Address - Street 1:7840 W 165TH ST STE 110
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223-3021
Practice Address - Country:US
Practice Address - Phone:913-632-3550
Practice Address - Fax:913-632-3559
Is Sole Proprietor?:No
Enumeration Date:2008-08-18
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1331133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1331OtherKANSAS LICENSE