Healthcare Provider Details

I. General information

NPI: 1962900308
Provider Name (Legal Business Name): HALEY B BJELOBRK MS, RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HALEY BETH NAGEL

II. Dates (important events)

Enumeration Date: 01/31/2018
Last Update Date: 12/26/2023
Certification Date: 12/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 CAMBRIDGE ST
KANSAS CITY KS
66160-2412
US

IV. Provider business mailing address

4000 CAMBRIDGE ST
KANSAS CITY KS
66160-8501
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-6022
  • Fax: 913-535-2102
Mailing address:
  • Phone: 913-588-6022
  • Fax: 913-535-2102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2016043593
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: