Healthcare Provider Details

I. General information

NPI: 1598498453
Provider Name (Legal Business Name): ALEXANDRA MAE GREGG RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 11/08/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 SW WINTERFIELD CT
LEES SUMMIT MO
64081-4098
US

IV. Provider business mailing address

8450 NW PR VW RD # 1441
KANSAS CITY MO
64153-1841
US

V. Phone/Fax

Practice location:
  • Phone: 816-875-0077
  • Fax: 507-322-1832
Mailing address:
  • Phone: 507-990-4403
  • Fax: 507-322-1832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2022025851
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: