Provider Demographics
NPI:1811504863
Name:KILPATRICK, KASEY MAE (RD, LD)
Entity type:Individual
Prefix:MS
First Name:KASEY
Middle Name:MAE
Last Name:KILPATRICK
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 1:2210 W DALLAS ST APT 421
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-4349
Mailing Address - Country:US
Mailing Address - Phone:817-734-7161
Mailing Address - Fax:
Practice Address - Street 1:2210 W DALLAS ST APT 421
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77019-4349
Practice Address - Country:US
Practice Address - Phone:817-734-7161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT85602133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered