Provider Demographics
NPI:1386940716
Name:STEWART, GLENNA YOKUM (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:GLENNA
Middle Name:YOKUM
Last Name:STEWART
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:GLENNA
Other - Middle Name:MARIE
Other - Last Name:YOKUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, RD, LD
Mailing Address - Street 1:5500 E KELLOGG DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-1607
Mailing Address - Country:US
Mailing Address - Phone:316-685-2221
Mailing Address - Fax:316-634-3065
Practice Address - Street 1:5500 E KELLOGG DR
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-1607
Practice Address - Country:US
Practice Address - Phone:316-685-2221
Practice Address - Fax:316-634-3065
Is Sole Proprietor?:No
Enumeration Date:2011-02-02
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1390133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered