Provider Demographics
NPI:1497560072
Name:HENIK, KACEY (RD)
Entity type:Individual
Prefix:
First Name:KACEY
Middle Name:
Last Name:HENIK
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3834 S ROGERS CIR
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-3601
Mailing Address - Country:US
Mailing Address - Phone:816-820-4615
Mailing Address - Fax:
Practice Address - Street 1:3834 S ROGERS CIR
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-3601
Practice Address - Country:US
Practice Address - Phone:816-820-4615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025003822133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered