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General NPI Number Information
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NPI Number | 1245799915
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Entity Type | Individual
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Provider Name | CASEY KIERNAN RDN, CPT
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Gender | Female
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Dates
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Enumeration Date | 03/13/2019
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Last Update Date | 03/25/2019
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Provider Practice Location Address
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Address Line | 4725 N FEDERAL HWY
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308-4603
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Country | US
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Telephone | 954-202-0277
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Fax |
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Provider Business Mailing Address
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Address Line | 3617 HIGH RIDGE WAY APT 306
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-8797
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 86082340
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License Number State | FL
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