Provider Demographics
NPI:1366017329
Name:KERRIGAN, CHRISTINE JUDITH (MS RD LDN)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:JUDITH
Last Name:KERRIGAN
Suffix:
Gender:F
Credentials:MS RD LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 PEARSON CIR
Mailing Address - Street 2:
Mailing Address - City:TRENT WOODS
Mailing Address - State:NC
Mailing Address - Zip Code:28562-7511
Mailing Address - Country:US
Mailing Address - Phone:570-575-0374
Mailing Address - Fax:
Practice Address - Street 1:603 PEARSON CIR
Practice Address - Street 2:
Practice Address - City:TRENT WOODS
Practice Address - State:NC
Practice Address - Zip Code:28562-7511
Practice Address - Country:US
Practice Address - Phone:570-575-0374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-23
Last Update Date:2021-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL005826133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered