Provider Demographics
NPI:1154814465
Name:BLAESSER, KERRI BETH (MS, RD)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:BETH
Last Name:BLAESSER
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 LORNA DOONE DR
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23692-3429
Mailing Address - Country:US
Mailing Address - Phone:530-651-4739
Mailing Address - Fax:
Practice Address - Street 1:136 LORNA DOONE DR
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23692-3429
Practice Address - Country:US
Practice Address - Phone:530-651-4739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic