Provider Demographics
NPI:1508310269
Name:ADAMS, MICHELLE (MS, RD, CSR, LD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:MS, RD, CSR, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5320 SHAWNEE VIEW CT
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025-4018
Mailing Address - Country:US
Mailing Address - Phone:816-679-2491
Mailing Address - Fax:
Practice Address - Street 1:5320 SHAWNEE VIEW CT
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MO
Practice Address - Zip Code:63025-4018
Practice Address - Country:US
Practice Address - Phone:816-679-2491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016002936133V00000X
133VN1005X
KS2064133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal