Healthcare Provider Details

I. General information

NPI: 1114666773
Provider Name (Legal Business Name): EMILY WINOKUR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 06/01/2022
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 W 121ST ST STE 121
OVERLAND PARK KS
66209-2005
US

IV. Provider business mailing address

2409 NE BRIDGEPORT DR
LEES SUMMIT MO
64086-5019
US

V. Phone/Fax

Practice location:
  • Phone: 816-520-2259
  • Fax:
Mailing address:
  • Phone: 816-520-2259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: