Provider Demographics
NPI:1710164868
Name:RUSH, KERRI L (RD, LDN, CDOE)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:L
Last Name:RUSH
Suffix:
Gender:F
Credentials:RD, LDN, CDOE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 FELICIA CT
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02889-3198
Mailing Address - Country:US
Mailing Address - Phone:401-480-9963
Mailing Address - Fax:
Practice Address - Street 1:198 BUTTONWOODS AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-7541
Practice Address - Country:US
Practice Address - Phone:401-480-9963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILDN00609133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered