Healthcare Provider Details

I. General information

NPI: 1841446150
Provider Name (Legal Business Name): LISA ANN MARKLEY MS, RDN, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 03/17/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7840 W 165TH ST STE 110
OVERLAND PARK KS
66223-3021
US

IV. Provider business mailing address

7840 W 165TH ST STE 110
OVERLAND PARK KS
66223-3021
US

V. Phone/Fax

Practice location:
  • Phone: 913-632-3550
  • Fax: 913-632-3559
Mailing address:
  • Phone: 913-632-3552
  • Fax: 913-632-3559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number1331
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: