Healthcare Provider Details

I. General information

NPI: 1255153151
Provider Name (Legal Business Name): KIM CASEY RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2024
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 BATTLEFIELD BLVD N
CHESAPEAKE VA
23320-4802
US

IV. Provider business mailing address

800 BATTLEFIELD BLVD N
CHESAPEAKE VA
23320-4802
US

V. Phone/Fax

Practice location:
  • Phone: 757-312-6521
  • Fax: 757-312-6245
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License NumberL007313
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: