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General NPI Number Information
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NPI Number | 1548989502
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Entity Type | Organization
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Legal Business Name | KCPEDSRD LLC
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Dates
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Enumeration Date | 08/24/2022
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Last Update Date | 11/08/2022
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Provider Practice Location Address
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Address Line | 2420 SW WINTERFIELD CT
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City | LEES SUMMIT
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State | MO
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Zip | 64081-4098
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Country | US
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Telephone | 816-875-0077
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Fax |
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Provider Business Mailing Address
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Address Line | 8450 NW PRAIRIE VIEW RD # 1441
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City | KANSAS CITY
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State | MO
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Zip | 64153-1841
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Country | US
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Telephone | 816-875-0077
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Fax | 507-322-1832
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Authorized Official
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Title or Position | DIETITIAN
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Name | MRS. ALEXANDRA MAE GREGG
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Credential | RD, LD
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Telephone | 816-875-0077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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