Healthcare Provider Details

I. General information

NPI: 1821454604
Provider Name (Legal Business Name): EMILY HASTINGS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

3800 S WHITNEY AVE STE 200
INDEPENDENCE MO
64055-6739
US

IV. Provider business mailing address

17501 E US HIGHWAY 40
INDEPENDENCE MO
64055-5442
US

V. Phone/Fax

Practice location:
  • Phone: 816-478-4887
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2015044689
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: