Provider Demographics
NPI:1851004097
Name:KEARNS, LAUREL RUTH (RD)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:RUTH
Last Name:KEARNS
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 1:11 ROAN DR
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-1291
Mailing Address - Country:US
Mailing Address - Phone:508-517-4161
Mailing Address - Fax:
Practice Address - Street 1:11 ROAN DR
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-1291
Practice Address - Country:US
Practice Address - Phone:508-517-4161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA164133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered