Provider Demographics
NPI:1154512028
Name:TALLEY, KERI M (RD, LD)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:M
Last Name:TALLEY
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1495 COUNTY ROAD 441
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35186-8049
Mailing Address - Country:US
Mailing Address - Phone:205-669-1870
Mailing Address - Fax:205-669-1637
Practice Address - Street 1:1495 COUNTY ROAD 441
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:AL
Practice Address - Zip Code:35186-8049
Practice Address - Country:US
Practice Address - Phone:205-669-1870
Practice Address - Fax:205-669-1637
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1395133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered