Provider Demographics
NPI:1659029585
Name:KERR, MATTHEW JAMES (RD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JAMES
Last Name:KERR
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:981 WILMINGTON DR
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-6524
Mailing Address - Country:US
Mailing Address - Phone:386-228-5594
Mailing Address - Fax:
Practice Address - Street 1:5100 NW 33RD AVE STE 245
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-6381
Practice Address - Country:US
Practice Address - Phone:786-605-9055
Practice Address - Fax:913-676-7358
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010974133V00000X
PADN007757133V00000X
NJ86102191133V00000X
OHLD.10046133V00000X
NMLD2022016133V00000X
RILDN01235133V00000X
FLND9464133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered