Healthcare Provider Details

I. General information

NPI: 1629695465
Provider Name (Legal Business Name): CASEY KWAN HOU MPH, RD, CNSC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2020
Last Update Date: 11/27/2023
Certification Date: 06/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 FOOTHILLS VILLAGE DR
HENDERSON NV
89012-7265
US

IV. Provider business mailing address

1420 FOOTHILLS VILLAGE DR
HENDERSON NV
89012-7265
US

V. Phone/Fax

Practice location:
  • Phone: 702-612-6882
  • Fax:
Mailing address:
  • Phone: 702-612-6882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number32910DI-0
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: