Provider Demographics
NPI:1508202375
Name:RISNER, KERRY MCCRYSTAL (RD CNSC LD)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:MCCRYSTAL
Last Name:RISNER
Suffix:
Gender:F
Credentials:RD CNSC LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:856 DENIER PL
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45224-1312
Mailing Address - Country:US
Mailing Address - Phone:513-306-7806
Mailing Address - Fax:
Practice Address - Street 1:856 DENIER PL
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45224-1312
Practice Address - Country:US
Practice Address - Phone:513-306-7806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3080133V00000X
KY2401133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered