Provider Demographics
NPI:1548456171
Name:SANDERSON, KASIE LYNN (NUTRITIONIST)
Entity type:Individual
Prefix:MRS
First Name:KASIE
Middle Name:LYNN
Last Name:SANDERSON
Suffix:
Gender:F
Credentials:NUTRITIONIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8215 MIDWAY DEPOT
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78255-2258
Mailing Address - Country:US
Mailing Address - Phone:210-478-5300
Mailing Address - Fax:
Practice Address - Street 1:9502 HUEBNER RD STE 301
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1683
Practice Address - Country:US
Practice Address - Phone:210-478-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist