Healthcare Provider Details

I. General information

NPI: 1447565619
Provider Name (Legal Business Name): KELI ANNE HURST RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2010
Last Update Date: 08/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 NE ENGLEWOOD RD
KANSAS CITY MO
64118-4586
US

IV. Provider business mailing address

9811 N WAYNE AVE
KANSAS CITY MO
64155-2131
US

V. Phone/Fax

Practice location:
  • Phone: 816-454-4776
  • Fax:
Mailing address:
  • Phone: 913-634-8037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2007000892
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: