Provider Demographics
NPI:1164053559
Name:LETT, KERRY MARIE (RDN, LDN, CLC)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:MARIE
Last Name:LETT
Suffix:
Gender:F
Credentials:RDN, LDN, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 KILDAIRE FARM RD
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-3433
Mailing Address - Country:US
Mailing Address - Phone:919-443-5240
Mailing Address - Fax:919-899-0667
Practice Address - Street 1:417 KILDAIRE FARM RD
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-3433
Practice Address - Country:US
Practice Address - Phone:919-443-5240
Practice Address - Fax:919-899-0667
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL006050133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered