Provider Demographics
NPI:1982350732
Name:DAY, KACI BROOKE (RD LD)
Entity type:Individual
Prefix:MS
First Name:KACI
Middle Name:BROOKE
Last Name:DAY
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 1:16 MARSHALL DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31535
Mailing Address - Country:US
Mailing Address - Phone:912-309-4595
Mailing Address - Fax:
Practice Address - Street 1:16 MARSHALL DR
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31535
Practice Address - Country:US
Practice Address - Phone:912-309-4595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD005439133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered