Provider Demographics
NPI:1548989502
Name:KCPEDSRD LLC
Entity type:Organization
Organization Name:KCPEDSRD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:GREGG
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:816-875-0077
Mailing Address - Street 1:8450 NW PRAIRIE VIEW RD # 1441
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64153-1841
Mailing Address - Country:US
Mailing Address - Phone:816-875-0077
Mailing Address - Fax:507-322-1832
Practice Address - Street 1:2420 SW WINTERFIELD CT
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64081-4098
Practice Address - Country:US
Practice Address - Phone:816-875-0077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-24
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty