Provider Demographics
NPI:1083983084
Name:CAUGHEY, KERRY BURKE (RD, LDN)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:BURKE
Last Name:CAUGHEY
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10431 PATTERSON AVE STE A2
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23238-5101
Mailing Address - Country:US
Mailing Address - Phone:804-506-3056
Mailing Address - Fax:
Practice Address - Street 1:10431 PATTERSON AVE STE A2
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23238-5101
Practice Address - Country:US
Practice Address - Phone:804-506-3056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-20
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003881133V00000X
VA1089545133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered