Provider Demographics
NPI:1023211240
Name:KERRONE, BARBARA (RD, CD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:KERRONE
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 TULALIP ST NE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98422-1645
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:311 S L ST
Practice Address - Street 2:MAILSTOP 311-W3-GI
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-3720
Practice Address - Country:US
Practice Address - Phone:253-403-4581
Practice Address - Fax:253-403-9179
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00000982133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA826-0044Medicaid