MEDICARE: JILL RASA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1114890670
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JILL RASA LLC

Provider Business Mailing Address
First Line	:	1204 NW 94TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64155-2567
Country	:	US
Telephone Number	:	816-820-0336
Fax Number	:

Provider Business Practice Location Address
First Line	:	1204 NW 94TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64155-2567
Country	:	US
Telephone Number	:	816-820-0336
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JILL RASA
Credential	:	RDN
Telephone Number	:	816-820-0336

Provider Enumeration Date	:	09/29/2025
Last Update Date	:	09/29/2025

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