Provider Demographics
NPI:1205266954
Name:KASPER, KATHERINE (RD, LD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:KASPER
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 1:1111 8TH ST
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:IA
Mailing Address - Zip Code:50036-2925
Mailing Address - Country:US
Mailing Address - Phone:515-432-6065
Mailing Address - Fax:515-432-3669
Practice Address - Street 1:1111 8TH ST
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:IA
Practice Address - Zip Code:50036-2925
Practice Address - Country:US
Practice Address - Phone:515-432-6065
Practice Address - Fax:515-432-3669
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-16
Last Update Date:2013-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002123133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered