Provider Demographics
NPI:1508505124
Name:TAYLOR, KERRI (RD)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:
Last Name:TAYLOR
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 1:1133 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7304
Mailing Address - Country:US
Mailing Address - Phone:910-239-3562
Mailing Address - Fax:877-889-2993
Practice Address - Street 1:1016 2ND AVE N STE 206G
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-8209
Practice Address - Country:US
Practice Address - Phone:910-239-3562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2443133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered