Provider Demographics
NPI:1740036128
Name:SOUZA, KERI ANN (RD, LD)
Entity type:Individual
Prefix:MRS
First Name:KERI
Middle Name:ANN
Last Name:SOUZA
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 WALLY LN
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36867-7329
Mailing Address - Country:US
Mailing Address - Phone:803-542-2734
Mailing Address - Fax:
Practice Address - Street 1:13 WALLY LN
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-7329
Practice Address - Country:US
Practice Address - Phone:803-542-2734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5424133V00000X
810689133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered