Healthcare Provider Details

I. General information

NPI: 1508310269
Provider Name (Legal Business Name): MICHELLE ADAMS MS, RD, CSR, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2016
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5320 SHAWNEE VIEW CT
EUREKA MO
63025-4018
US

IV. Provider business mailing address

5320 SHAWNEE VIEW CT
EUREKA MO
63025-4018
US

V. Phone/Fax

Practice location:
  • Phone: 816-679-2491
  • Fax:
Mailing address:
  • Phone: 816-679-2491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2016002936
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: