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Deactivated NPI 1205419629 Deactivated / Inactive NPI Female Practitioner

Dr. Kathy Kemper Stanczyk , PhD, RD, LD

Dietitian, Registered • Marion, IL

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Kathy Stanczyk has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date May 03, 2021
NPI Deactivation Date December 04, 2025
Total Practice Duration ~4 Years of Practice (2021 – 2025)

Professional Overview & Biography Verified Profile Summary

Dr. Kathy Stanczyk, PhD, RD, LD was a registered Dietitian, Registered practicing in Marion, IL. Throughout an active medical career spanning 4 years, Dr. Stanczyk provided care at the practice location at 2401 W MAIN ST until profile deactivation on 2025-12-04.

Practice Location & Contact Primary Location

Practice Address

2401 W Main St

Marion, IL 629591188

Telephone 2709701811
Associated Practice Facility / Clinic
🏢 St. Louis Jc Vamc Facility NPI 1750349429

Specialty Benchmarks & Practice Insights

Comparative analytics for Dietitian, Registered in Marion, IL

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 16.7 Yrs
Regional Practice Density
19 Specialists

Practicing in Marion, IL (2895 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Dietitian, Registered Primary Specialty

NUCC Taxonomy Code: 133V00000X

State License KY 121241

A Registered Dietitian (RD)/Registered Dietitian Nutritionist (RDN) is an individual uniquely trained in the science of nutrition and practice of dietetics to design and provide medical nutrition therapy (MNT) and other evidence-based applications of the Nutrition Care Process (NCP) that exemplify the profession's systematic approach to providing high quality nutrition care. Registered dietitians provide MNT for the purpose of disease prevention or management, or to treat or rehabilitate an illness, injury, or condition, with the use of specific, indicated physical and cognitive nutrition care services comprised of one or more of the following aspects of the NCP: nutrition assessment/reassessment, nutrition diagnosis, nutrition intervention (e.g., nutrition counseling, therapeutic diet ordering, and nutrition education) and nutrition monitoring and evaluation.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

40 Associated Practitioners
Michele Otto , RN

Registered Nurse

NPI 1003515420

Registered Nurse

Aaron Ruzich

Physical Therapy Assistant

NPI 1003670548
NPI 1003672486

REGISTEREDNURSE

Ray Bayer , OTR, L

Occupational Therapist

NPI 1003822917

Occupational Therapist Registered, L

NPI 1013511922

Master of Science, Doctor of Philosophy (Ph.D.), Registered Dietitian, Registered Dietitian Nutritionist

Tameeka Marvin

Registered Nurse

NPI 1013613397

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated December 04, 2025

Record deactivated on December 04, 2025

NPI Profile Active May 03, 2021

NPI status registered as active in NPPES database

📍
Updated Practice Location May 03, 2021

Registered at 2401 W MAIN ST, MARION, IL 629591188 (Tel: 2709701811)

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Updated Business Mailing Address May 03, 2021

Registered at 164 BLISSFUL VIEW DR, MURRAY, KY 420714460 (Tel: 2709701811)

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Provider Name / Credentials Updated May 03, 2021

Recorded as KATHY STANCZYK, PHD, RD, LD

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Medical Taxonomy / Specialty Registered (Primary Specialty) May 03, 2021

Dietitian, Registered (License #121241 in KY)

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Initial NPI Registration & Enumeration May 03, 2021

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1205419629
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: May 03, 2021
Last Update: May 03, 2021
Deactivation Date: December 04, 2025

Mailing Address

164 Blissful View Dr

Murray, KY 420714460

Phone: 2709701811

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.