Healthcare Provider Details

I. General information

NPI: 1558296483
Provider Name (Legal Business Name): KATHY ANN MERTZUFFT RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7831 S RANGELINE RD
COLUMBIA MO
65201-9766
US

IV. Provider business mailing address

7831 S RANGELINE RD
COLUMBIA MO
65201-9766
US

V. Phone/Fax

Practice location:
  • Phone: 573-881-2222
  • Fax:
Mailing address:
  • Phone: 573-881-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2005001320
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: