Provider Demographics
NPI:1821661158
Name:KENNEDY, KERRY B (RDN, LD)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:B
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9710 KATY FWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-6213
Mailing Address - Country:US
Mailing Address - Phone:855-481-1149
Mailing Address - Fax:855-710-7869
Practice Address - Street 1:9710 KATY FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-6213
Practice Address - Country:US
Practice Address - Phone:855-481-1149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered