Provider Demographics
NPI:1235637562
Name:EMGE, KACY ANN (RD, LD)
Entity Type:Individual
Prefix:
First Name:KACY
Middle Name:ANN
Last Name:EMGE
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:KACY
Other - Middle Name:ANN
Other - Last Name:SHAFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:PO BOX 23340
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63156-3340
Mailing Address - Country:US
Mailing Address - Phone:314-851-1000
Mailing Address - Fax:314-851-4445
Practice Address - Street 1:12655 OLIVE BLVD FL 4
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6291
Practice Address - Country:US
Practice Address - Phone:314-851-1000
Practice Address - Fax:314-851-4445
Is Sole Proprietor?:No
Enumeration Date:2018-02-01
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
MO2018009252133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered