Provider Demographics
NPI:1205980174
Name:MILLER, KERRIE E (RD, LDN)
Entity type:Individual
Prefix:MRS
First Name:KERRIE
Middle Name:E
Last Name:MILLER
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:MS
Other - First Name:KERRIE
Other - Middle Name:E
Other - Last Name:AMICONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LDN
Mailing Address - Street 1:4005 OLEANDER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6816
Mailing Address - Country:US
Mailing Address - Phone:910-790-9949
Mailing Address - Fax:
Practice Address - Street 1:4005 OLEANDER DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6816
Practice Address - Country:US
Practice Address - Phone:910-790-9949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003368133V00000X
NCL003170133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered