Provider Demographics
NPI:1487967071
Name:MCCREERY, MARY MARGARET (RD)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:MARGARET
Last Name:MCCREERY
Suffix:
Gender:F
Credentials:RD
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Mailing Address - Street 1:12713 HIGHWAY M
Mailing Address - Street 2:
Mailing Address - City:STARK CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64866-8053
Mailing Address - Country:US
Mailing Address - Phone:417-850-2013
Mailing Address - Fax:417-347-9268
Practice Address - Street 1:113 W HICKORY ST
Practice Address - Street 2:
Practice Address - City:NEOSHO
Practice Address - State:MO
Practice Address - Zip Code:64850-1705
Practice Address - Country:US
Practice Address - Phone:417-347-4309
Practice Address - Fax:417-347-9268
Is Sole Proprietor?:No
Enumeration Date:2010-07-23
Last Update Date:2010-08-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2002008087133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO916277OtherREGISTAR DIETITAN LICENSE
2041-0267OtherCERTIFIED DIABETES EDUCATOR
MO20020080887OtherSTATE COMMITTE OF DIETITIAN LICENSED