Provider Demographics
NPI:1952139214
Name:JOHNSON, KADY (RDN)
Entity type:Individual
Prefix:
First Name:KADY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7406 E 45TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57110-6449
Mailing Address - Country:US
Mailing Address - Phone:605-951-3634
Mailing Address - Fax:
Practice Address - Street 1:7406 E 45TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57110-6449
Practice Address - Country:US
Practice Address - Phone:605-951-3634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD86392945133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered