Healthcare Provider Details

I. General information

NPI: 1649601683
Provider Name (Legal Business Name): RACHAEL JEAN SHINKLE RD LD CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2013
Last Update Date: 10/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 N 7TH ST
FREDONIA KS
66736-1337
US

IV. Provider business mailing address

8220 ELK RD
FREDONIA KS
66736-7460
US

V. Phone/Fax

Practice location:
  • Phone: 620-288-0774
  • Fax:
Mailing address:
  • Phone: 620-288-0774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1832
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: