Provider Demographics
NPI:1851048805
Name:REZAC, KASLYN (MS, RD)
Entity Type:Individual
Prefix:
First Name:KASLYN
Middle Name:
Last Name:REZAC
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16565 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-6104
Mailing Address - Country:US
Mailing Address - Phone:402-689-4217
Mailing Address - Fax:
Practice Address - Street 1:16565 LOCUST ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-6104
Practice Address - Country:US
Practice Address - Phone:402-689-4217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1600133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered