Healthcare Provider Details

I. General information

NPI: 1992967806
Provider Name (Legal Business Name): LINETTE AYERS MS,RD,LD,CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2008
Last Update Date: 07/01/2008
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

2401 GILLHAM RD
KANSAS CITY MO
64108-4619
US

V. Phone/Fax

Practice location:
  • Phone: 816-983-6909
  • Fax: 816-855-1986
Mailing address:
  • Phone: 816-983-6909
  • Fax: 816-855-1986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number2004008858
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: