Provider Demographics
NPI:1952455560
Name:MATSON, KAREN SUE (RD LD CDE)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:SUE
Last Name:MATSON
Suffix:
Gender:F
Credentials:RD LD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21905 ONAGA RD N
Mailing Address - Street 2:
Mailing Address - City:ONAGA
Mailing Address - State:KS
Mailing Address - Zip Code:66521-9505
Mailing Address - Country:US
Mailing Address - Phone:785-889-4362
Mailing Address - Fax:
Practice Address - Street 1:3313B THRASHER RD
Practice Address - Street 2:
Practice Address - City:WHITE CLOUD
Practice Address - State:KS
Practice Address - Zip Code:66094-4028
Practice Address - Country:US
Practice Address - Phone:785-595-3450
Practice Address - Fax:785-595-3493
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS403133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered