Healthcare Provider Details

I. General information

NPI: 1942172614
Provider Name (Legal Business Name): CREATIVELY WELL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2025
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5508 NW MOONLIGHT MEADOW DR
LEES SUMMIT MO
64064-1283
US

IV. Provider business mailing address

18423 MARIES ROAD 505
DIXON MO
65459-7465
US

V. Phone/Fax

Practice location:
  • Phone: 417-209-4540
  • Fax: 800-861-1359
Mailing address:
  • Phone: 417-209-4540
  • Fax: 800-861-1359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: NATALIE MARTIN
Title or Position: OWNER
Credential: MS, RD, LD
Phone: 417-209-4540