Provider Demographics
NPI:1992730097
Name:GIVENS, OWENITA R (RD/LD)
Entity type:Individual
Prefix:
First Name:OWENITA
Middle Name:R
Last Name:GIVENS
Suffix:
Gender:F
Credentials:RD/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 937
Mailing Address - Street 2:445 HILLTOP
Mailing Address - City:ELKHART
Mailing Address - State:KS
Mailing Address - Zip Code:67950
Mailing Address - Country:US
Mailing Address - Phone:620-697-2141
Mailing Address - Fax:620-697-4766
Practice Address - Street 1:445 HILLTOP
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:KS
Practice Address - Zip Code:67950-0937
Practice Address - Country:US
Practice Address - Phone:620-697-2141
Practice Address - Fax:620-697-4766
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS305133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
130615Medicare ID - Type Unspecified