MEDICARE: HEIDI A STEVENS RDN, LD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	878	KS

General Provider Information

NPI Number	:	1548446941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI A STEVENS RDN, LD

Provider Business Mailing Address
First Line	:	1202 STEELE AVE
Second Line	:
City	:	SCOTT CITY
State	:	KS
Zip	:	67871-1364
Country	:	US
Telephone Number	:	620-874-5074
Fax Number	:

Provider Business Practice Location Address
First Line	:	1202 STEELE AVE
Second Line	:
City	:	SCOTT CITY
State	:	KS
Zip	:	67871-1364
Country	:	US
Telephone Number	:	620-874-5074
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2008
Last Update Date	:	02/28/2023

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