Provider Demographics
NPI:1477963544
Name:MCKERCHER, STEPHANIE (MS, RDN)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:MCKERCHER
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:COOGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5119 WILLIAMS FORK TRL
Mailing Address - Street 2:#106
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-3439
Mailing Address - Country:US
Mailing Address - Phone:414-412-7884
Mailing Address - Fax:
Practice Address - Street 1:5119 WILLIAMS FORK TRL
Practice Address - Street 2:#106
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-3439
Practice Address - Country:US
Practice Address - Phone:414-412-7884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-29
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered