Provider Demographics
NPI:1316311582
Name:SHARP, KACI (RDN, LRD)
Entity type:Individual
Prefix:
First Name:KACI
Middle Name:
Last Name:SHARP
Suffix:
Gender:F
Credentials:RDN, LRD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 MOUNTAIN ST E
Mailing Address - Street 2:
Mailing Address - City:CAVALIER
Mailing Address - State:ND
Mailing Address - Zip Code:58220-4015
Mailing Address - Country:US
Mailing Address - Phone:701-265-6115
Mailing Address - Fax:
Practice Address - Street 1:301 MOUNTAIN ST E
Practice Address - Street 2:
Practice Address - City:CAVALIER
Practice Address - State:ND
Practice Address - Zip Code:58220-4015
Practice Address - Country:US
Practice Address - Phone:701-265-6338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND990133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered