| Mary Daniel Johnson, RD | |
|
2790 Clay Edwards Dr Ste 600, North Kansas City, MO 64116-3274 | |
| (816) 691-5048 | |
| (816) 346-7039 |
| Full Name | Mary Daniel Johnson |
|---|---|
| Gender | Female |
| Speciality | Dietitian, Registered |
| Location | 2790 Clay Edwards Dr Ste 600, North Kansas City, Missouri |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487201703 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 133V00000X | Dietitian, Registered | 1935 (Arkansas) | Secondary |
| 133V00000X | Dietitian, Registered | 2021034269 (Missouri) | Primary |
| Provider Name | Northeast Arkansas Clinic Charitable Foundation, Inc. |
|---|---|
| Provider Type | Part B Supplier - Clinic/group Practice |
| Provider Identifiers | NPI Number: 1861721839 PECOS PAC ID: 2961547526 Enrollment ID: O20100315000190 |
| Mailing Address | Practice Location Address |
|---|---|
| Mary Daniel Johnson, RD 2790 Clay Edwards Dr Ste 600, North Kansas City, MO 64116-3274 Ph: (816) 691-5048 | Mary Daniel Johnson, RD 2790 Clay Edwards Dr Ste 600, North Kansas City, MO 64116-3274 Ph: (816) 691-5048 |
Kayla Melanson, RD Dietitian Medicare: Not Enrolled in Medicare Practice Location: 2800 Clay Edwards Dr, North Kansas City, MO 64116 Phone: 816-691-8183 | |
Mrs. Janet Lyn Anderson, RD, LD Dietitian Medicare: Not Enrolled in Medicare Practice Location: 2800 Clay Edwards Dr, North Kansas City, MO 64116 Phone: 816-691-8184 Fax: 816-346-7073 | |
Mr. Jace Tyler Galloway, RD, RDN Dietitian Medicare: Not Enrolled in Medicare Practice Location: 2800 Clay Edwards Dr, North Kansas City, MO 64116 Phone: 816-691-2000 | |
Lexi Resa, RD, LD Dietitian Medicare: Not Enrolled in Medicare Practice Location: 2800 Clay Edwards Dr, North Kansas City, MO 64116 Phone: 816-691-2000 | |
Michelle Garcia, RD Dietitian Medicare: Accepting Medicare Assignments Practice Location: 2790 Clay Edwards Dr Ste 600, North Kansas City, MO 64116 Phone: 816-691-5048 Fax: 816-346-7039 | |
Ms. Lindsey Kay Moore, MS, RDN, LD Dietitian Medicare: Not Enrolled in Medicare Practice Location: 2800 Clay Edwards Dr, North Kansas City, MO 64116 Phone: 816-691-2000 | |
Jenna Koeneman, Dietitian Medicare: Not Enrolled in Medicare Practice Location: 2800 Clay Edwards Dr, North Kansas City, MO 64116 Phone: 816-691-2000 |