Provider Demographics
NPI:1376984294
Name:JENNINGS, KERRI-ANN (MS, RD)
Entity Type:Individual
Prefix:
First Name:KERRI-ANN
Middle Name:
Last Name:JENNINGS
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 1:16 FERGUSON AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-5313
Mailing Address - Country:US
Mailing Address - Phone:202-360-9764
Mailing Address - Fax:
Practice Address - Street 1:15 PEARL ST
Practice Address - Street 2:
Practice Address - City:ESSEX JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05452-3652
Practice Address - Country:US
Practice Address - Phone:802-448-0890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT074.0094226133V00000X
WA60632328133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered