Provider Demographics
NPI:1912564030
Name:STROUSE, KASEY (RDN, LDN, CEDS)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:
Last Name:STROUSE
Suffix:
Gender:F
Credentials:RDN, LDN, CEDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 PARK RD STE 222
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-3669
Mailing Address - Country:US
Mailing Address - Phone:704-266-0864
Mailing Address - Fax:919-386-4604
Practice Address - Street 1:5200 PARK RD STE 222
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-3669
Practice Address - Country:US
Practice Address - Phone:704-266-0864
Practice Address - Fax:919-386-4604
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-23
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL005759133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered