Healthcare Provider Details

I. General information

NPI: 1578387429
Provider Name (Legal Business Name): KASIE ELIZABETH RAWSON RDN, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2024
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 SPICEWOOD SPRINGS RD STE 1022
AUSTIN TX
78759-8543
US

IV. Provider business mailing address

10909 SENTINEL DR
AUSTIN TX
78747-2834
US

V. Phone/Fax

Practice location:
  • Phone: 512-257-0898
  • Fax:
Mailing address:
  • Phone: 413-329-6360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT89768
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: