Provider Demographics
NPI:1437588373
Name:SWACKER, KERRY MITCHELL (RD, LD)
Entity Type:Individual
Prefix:MISS
First Name:KERRY
Middle Name:MITCHELL
Last Name:SWACKER
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:LYNN
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD, LD
Mailing Address - Street 1:168 DEER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:TX
Mailing Address - Zip Code:76008-3900
Mailing Address - Country:US
Mailing Address - Phone:817-343-1619
Mailing Address - Fax:
Practice Address - Street 1:168 DEER CREEK DR
Practice Address - Street 2:
Practice Address - City:ALEDO
Practice Address - State:TX
Practice Address - Zip Code:76008-3900
Practice Address - Country:US
Practice Address - Phone:817-343-1619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT05772133N00000X, 133V00000X, 133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic