Individual
KACI BLACKSHEAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
538 BROADWAY, WINNIE, TX 77665-7600
(409) 296-6000
(409) 296-6372
Mailing address
538 BROADWAY, WINNIE, TX 77665-7600
(409) 296-6000
(409) 296-6372
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DT89065
TX
Other
Enumeration date
11/03/2023
Last updated
11/03/2023
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