Provider Demographics
NPI:1952910119
Name:METZ, KERRI E (MS, RD/LD, IBCLC)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:E
Last Name:METZ
Suffix:
Gender:F
Credentials:MS, RD/LD, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:548 DYEA AVE APT A
Mailing Address - Street 2:
Mailing Address - City:JBER
Mailing Address - State:AK
Mailing Address - Zip Code:99505-1134
Mailing Address - Country:US
Mailing Address - Phone:907-887-4636
Mailing Address - Fax:
Practice Address - Street 1:9100 CENTENNIAL CIR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-1480
Practice Address - Country:US
Practice Address - Phone:907-333-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK256133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered