Provider Demographics
NPI:1962900308
Name:BJELOBRK, HALEY B (MS, RDN)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:B
Last Name:BJELOBRK
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:BETH
Other - Last Name:NAGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4000 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-8501
Mailing Address - Country:US
Mailing Address - Phone:913-588-6022
Mailing Address - Fax:913-535-2102
Practice Address - Street 1:4000 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-2412
Practice Address - Country:US
Practice Address - Phone:913-588-6022
Practice Address - Fax:913-535-2102
Is Sole Proprietor?:No
Enumeration Date:2018-01-31
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016043593133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS2154OtherKANSAS LICENSED DIETITIAN
MO2016043593OtherMISSOURI LICENSED DIETITIAN
AR86064172OtherCOMMISSION ON DIETETIC REGISTRATION ID