Provider Demographics
NPI:1083130017
Name:BROGLE, KACIE DANIELLE (RD)
Entity Type:Individual
Prefix:
First Name:KACIE
Middle Name:DANIELLE
Last Name:BROGLE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 N COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:HARRODSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40330-1089
Mailing Address - Country:US
Mailing Address - Phone:859-734-2229
Mailing Address - Fax:859-734-0568
Practice Address - Street 1:900 N COLLEGE ST
Practice Address - Street 2:
Practice Address - City:HARRODSBURG
Practice Address - State:KY
Practice Address - Zip Code:40330-1089
Practice Address - Country:US
Practice Address - Phone:859-734-2229
Practice Address - Fax:859-734-0568
Is Sole Proprietor?:No
Enumeration Date:2017-08-22
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY173874133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered