Provider Demographics
NPI:1811343239
Name:HERMAN, KALIE ANNE (MS, RD)
Entity type:Individual
Prefix:MISS
First Name:KALIE
Middle Name:ANNE
Last Name:HERMAN
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3817 72ND TER E
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-5160
Mailing Address - Country:US
Mailing Address - Phone:847-409-5244
Mailing Address - Fax:
Practice Address - Street 1:10400 MALLARD CREEK CHURCH ROAD
Practice Address - Street 2:340
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262
Practice Address - Country:US
Practice Address - Phone:704-549-9550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered