Provider Demographics
NPI:1386222891
Name:JERKE, KATHERINE LINDSAY (RDN)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:LINDSAY
Last Name:JERKE
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13245 FAIRCOURT LN SE
Mailing Address - Street 2:
Mailing Address - City:RAINIER
Mailing Address - State:WA
Mailing Address - Zip Code:98576-9709
Mailing Address - Country:US
Mailing Address - Phone:240-575-8140
Mailing Address - Fax:
Practice Address - Street 1:1651 COOPER POINT RD SW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5735
Practice Address - Country:US
Practice Address - Phone:360-956-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61117699133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered