Provider Demographics
NPI:1497187157
Name:KERSHNER, KARAN MARIE (RD,LD)
Entity Type:Individual
Prefix:
First Name:KARAN
Middle Name:MARIE
Last Name:KERSHNER
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 AMY CT
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76233-5413
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:124 AMY CT
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:TX
Practice Address - Zip Code:76233-5413
Practice Address - Country:US
Practice Address - Phone:817-320-9823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT82686133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education