Healthcare Provider Details

I. General information

NPI: 1801617378
Provider Name (Legal Business Name): FOOD COACH ME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5505 FOXRIDGE DR STE 105
MISSION KS
66202-1556
US

IV. Provider business mailing address

5505 FOXRIDGE DR STE 105
MISSION KS
66202-1556
US

V. Phone/Fax

Practice location:
  • Phone: 913-717-9948
  • Fax: 913-382-7434
Mailing address:
  • Phone: 405-623-3399
  • Fax: 913-382-7434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE WAGNER
Title or Position: REGISTERED DIETITIAN
Credential: MS, RDN
Phone: 405-623-3399