Provider Demographics
NPI:1235244799
Name:KERICK, ANDREA LEACH (RD, LDN, CDE)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LEACH
Last Name:KERICK
Suffix:
Gender:F
Credentials:RD, LDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8340 BANDFORD WAY
Mailing Address - Street 2:STE 1
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-2755
Mailing Address - Country:US
Mailing Address - Phone:919-368-3173
Mailing Address - Fax:
Practice Address - Street 1:8340 BANDFORD WAY
Practice Address - Street 2:SUITE. 001
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-2755
Practice Address - Country:US
Practice Address - Phone:919-845-3332
Practice Address - Fax:919-845-3395
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002313133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered