Provider Demographics
NPI:1528020088
Name:STORY, KERRYN L (MPH, RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:KERRYN
Middle Name:L
Last Name:STORY
Suffix:
Gender:F
Credentials:MPH, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 HUNTERS TRL
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-7514
Mailing Address - Country:US
Mailing Address - Phone:910-717-7193
Mailing Address - Fax:
Practice Address - Street 1:1314 HUNTERS TRL
Practice Address - Street 2:
Practice Address - City:HOPE MILLS
Practice Address - State:NC
Practice Address - Zip Code:28348-7514
Practice Address - Country:US
Practice Address - Phone:910-717-7193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06235133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered