Provider Demographics
NPI:1982973129
Name:CALLAHAN, MEGAN NICOLE (MS, RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:NICOLE
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 NE RICE RD
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-2979
Mailing Address - Country:US
Mailing Address - Phone:816-524-5760
Mailing Address - Fax:816-246-5842
Practice Address - Street 1:1307 E NORTH AVE
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:MO
Practice Address - Zip Code:64012-5109
Practice Address - Country:US
Practice Address - Phone:816-318-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-16
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011007156133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered