Provider Demographics
NPI:1497487235
Name:MICK, ALISSA NICOLE (RDN)
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:NICOLE
Last Name:MICK
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7540 LACKMAN RD
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66217-9420
Mailing Address - Country:US
Mailing Address - Phone:913-617-9219
Mailing Address - Fax:
Practice Address - Street 1:1201 POYNTZ AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-4361
Practice Address - Country:US
Practice Address - Phone:785-510-3008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered