Provider Demographics
NPI:1275685828
Name:KASTAN, BEVERLY KAY (RD, MS, MLDE)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:KAY
Last Name:KASTAN
Suffix:
Gender:F
Credentials:RD, MS, MLDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5802 BRITTANY VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-5904
Mailing Address - Country:US
Mailing Address - Phone:502-891-0360
Mailing Address - Fax:502-891-0360
Practice Address - Street 1:5802 BRITTANY VALLEY RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-5904
Practice Address - Country:US
Practice Address - Phone:502-891-0360
Practice Address - Fax:502-891-0360
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY0025133V00000X
KY169351133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY10654330662OtherHUMANA
KY176894OtherANTHEM BLUE CROSS BLUE SH
KY6300003OtherUNITED HEALTH
KY176894OtherANTHEM BLUE CROSS BLUE SH
KY10654330662OtherHUMANA