Provider Demographics
NPI:1548446941
Name:STEVENS, HEIDI A (RDN, LD)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:A
Last Name:STEVENS
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 STEELE AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTT CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67871-1364
Mailing Address - Country:US
Mailing Address - Phone:620-874-5074
Mailing Address - Fax:
Practice Address - Street 1:1202 STEELE AVE
Practice Address - Street 2:
Practice Address - City:SCOTT CITY
Practice Address - State:KS
Practice Address - Zip Code:67871-1364
Practice Address - Country:US
Practice Address - Phone:620-874-5074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-15
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS878133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered