Healthcare Provider Details

I. General information

NPI: 1548456171
Provider Name (Legal Business Name): KASIE LYNN SANDERSON NUTRITIONIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 09/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9502 HUEBNER RD STE 301
SAN ANTONIO TX
78240-1683
US

IV. Provider business mailing address

8215 MIDWAY DEPOT
SAN ANTONIO TX
78255-2258
US

V. Phone/Fax

Practice location:
  • Phone: 210-478-5300
  • Fax:
Mailing address:
  • Phone: 210-478-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: