Provider Demographics
NPI:1760085153
Name:POLL, KACIE (RD LD)
Entity Type:Individual
Prefix:
First Name:KACIE
Middle Name:
Last Name:POLL
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 TAMARRON BLVD APT 3201
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-8018
Mailing Address - Country:US
Mailing Address - Phone:224-392-0859
Mailing Address - Fax:
Practice Address - Street 1:1717 SCOTTSDALE DR STE 220
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78641-4770
Practice Address - Country:US
Practice Address - Phone:512-640-9965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered