MEDICARE: REBECCA LYNN FORREST 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	2011013581	MO

General Provider Information

NPI Number	:	1871838763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA LYNN FORREST MS, RD, LD

Provider Business Mailing Address
First Line	:	7223 NW DONOVAN DR
Second Line	:	#1222
City	:	KANSAS CITY
State	:	MO
Zip	:	64153-2401
Country	:	US
Telephone Number	:	913-220-0331
Fax Number	:

Provider Business Practice Location Address
First Line	:	5330 NW 64TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64151-2414
Country	:	US
Telephone Number	:	816-505-1311
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2012
Last Update Date	:	06/04/2013

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