Provider Demographics
NPI:1821204173
Name:KERIN, ALLISON BRADSHAW (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:BRADSHAW
Last Name:KERIN
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 108TH PL
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-6040
Mailing Address - Country:US
Mailing Address - Phone:806-725-4571
Mailing Address - Fax:
Practice Address - Street 1:5022 AVENUE Q
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79412-2700
Practice Address - Country:US
Practice Address - Phone:806-725-5460
Practice Address - Fax:806-765-0760
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06884133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered