Provider Demographics
NPI:1467578559
Name:BURT, GERI L (RD,)
Entity Type:Individual
Prefix:MS
First Name:GERI
Middle Name:L
Last Name:BURT
Suffix:
Gender:F
Credentials:RD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 FOX RUN DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28792-7231
Mailing Address - Country:US
Mailing Address - Phone:828-693-8979
Mailing Address - Fax:
Practice Address - Street 1:103 ELK PARK DR
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-2058
Practice Address - Country:US
Practice Address - Phone:828-255-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL000127133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered