Provider Demographics
NPI:1790559540
Name:NELSON, CASEY (RD, LD)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:NELSON
Suffix:
Gender:M
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 1:538 E SKYLARK ST
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:KS
Mailing Address - Zip Code:66030-1844
Mailing Address - Country:US
Mailing Address - Phone:785-766-7429
Mailing Address - Fax:
Practice Address - Street 1:4320 WORNALL RD STE 530
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5942
Practice Address - Country:US
Practice Address - Phone:816-932-4931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered