Healthcare Provider Details

I. General information

NPI: 1912825332
Provider Name (Legal Business Name): KASEE BOGLE CFN-P
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8603 KILIKENNY CV
FORT WAYNE IN
46835-9125
US

IV. Provider business mailing address

8603 KILIKENNY CV
FORT WAYNE IN
46835-9125
US

V. Phone/Fax

Practice location:
  • Phone: 260-452-4535
  • Fax:
Mailing address:
  • Phone: 260-452-4535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: