Provider Demographics
NPI:1942613302
Name:KERSH, GINA ANNE (RDN, LD)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:ANNE
Last Name:KERSH
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:MRS
Other - First Name:GINA
Other - Middle Name:ANNE
Other - Last Name:BARNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:214 W MODESTO AVE
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-2324
Mailing Address - Country:US
Mailing Address - Phone:479-651-8547
Mailing Address - Fax:844-755-5666
Practice Address - Street 1:214 W MODESTO AVE
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-2324
Practice Address - Country:US
Practice Address - Phone:479-651-8547
Practice Address - Fax:844-755-5666
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARREGISTRATION 818990133N00000X
AR0449133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133N00000XDietary & Nutritional Service ProvidersNutritionist