Healthcare Provider Details

I. General information

NPI: 1861656597
Provider Name (Legal Business Name): JARROD D DUSIN M.S., R.D., L.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2008
Last Update Date: 07/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 GILLHAM RD
KANSAS CITY MO
64108-4619
US

IV. Provider business mailing address

10106 W 92ND PL
OVERLAND PARK KS
66212-4905
US

V. Phone/Fax

Practice location:
  • Phone: 816-481-9345
  • Fax:
Mailing address:
  • Phone: 816-481-9345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number200400326
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number1209
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: