Provider Demographics
NPI:1457977159
Name:KEPHART, KASIE (MS, NBC-HWC)
Entity type:Individual
Prefix:
First Name:KASIE
Middle Name:
Last Name:KEPHART
Suffix:
Gender:F
Credentials:MS, NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 41ST AVE N APT 211
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-4851
Mailing Address - Country:US
Mailing Address - Phone:813-481-8416
Mailing Address - Fax:
Practice Address - Street 1:150 41ST AVE N APT 211
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-4851
Practice Address - Country:US
Practice Address - Phone:813-481-8416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-18
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLA-3253789171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
Provider Identifiers
StateIdentifier IDID TypeIssuer
A-3253789OtherNATIONAL BOARD CERTIFIED HEALTH AND WELLNESS COACH