Provider Demographics
NPI:1376138164
Name:HECKERT, KERRI BL (MS, RD, LDN, CEDS-S)
Entity Type:Individual
Prefix:MRS
First Name:KERRI
Middle Name:BL
Last Name:HECKERT
Suffix:
Gender:F
Credentials:MS, RD, LDN, CEDS-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 WEST LANCASTER AVENUE
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010
Mailing Address - Country:US
Mailing Address - Phone:610-255-7079
Mailing Address - Fax:
Practice Address - Street 1:755 WEST LANCASTER AVENUE
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010
Practice Address - Country:US
Practice Address - Phone:610-255-7079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-04
Last Update Date:2022-10-18
Deactivation Date:2022-02-02
Deactivation Code:
Reactivation Date:2022-10-14
Provider Licenses
StateLicense IDTaxonomies
PADN004909133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric