Provider Demographics
NPI:1457013591
Name:GERDING, HEATHER KELSO (RDN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:KELSO
Last Name:GERDING
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 1:615 DREAM ISLAND RD # 302
Mailing Address - Street 2:
Mailing Address - City:LONGBOAT KEY
Mailing Address - State:FL
Mailing Address - Zip Code:34228-1502
Mailing Address - Country:US
Mailing Address - Phone:973-941-2931
Mailing Address - Fax:
Practice Address - Street 1:615 DREAM ISLAND RD # 302
Practice Address - Street 2:
Practice Address - City:LONGBOAT KEY
Practice Address - State:FL
Practice Address - Zip Code:34228-1502
Practice Address - Country:US
Practice Address - Phone:973-941-2931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10509133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered