MEDICARE: JILL RASA MS, RD, LD

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	1410	KS
2	133V00000X	Registered Dietitian	2007018948	MO

General Provider Information

NPI Number	:	1871756643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL RASA MS, RD, LD

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2008
Last Update Date	:	04/02/2024

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