=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558296483
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHY ANN MERTZUFFT RD, LD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2026
-----------------------------------------------------
Last Update Date | 06/13/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7831 S RANGELINE RD
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65201-9766
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-881-2222
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7831 S RANGELINE RD
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65201-9766
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-881-2222
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | 2005001320
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------