Individual provider · NPI-1

Casey L Frederick, RDN, LD

Dietitian, Registered · Broomfield, CO

NPI number1063203271
StatusActive
Last updated in NPPESMay 15, 2025

Details

NPI
1063203271
Entity type
Individual (NPI-1)
Name
Casey L Frederick
Credential
RDN, LD
Sex
Female
Sole proprietor
Yes
Enumeration date
May 15, 2025
Certification date
May 15, 2025
Last updated
May 15, 2025

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
133V00000X Dietitian, Registered86168424COYes

Practice location

13630 Via Varra Apt 223
Broomfield, CO 80020-9709

Phone 812-582-1093

Mailing address

13630 Via Varra Apt 223
Broomfield, CO 80020-9709

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