Provider Demographics
NPI:1154195444
Name:KERR, TAMMILEE K (RDN)
Entity type:Individual
Prefix:
First Name:TAMMILEE
Middle Name:K
Last Name:KERR
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 MOUNT JOY AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-1425
Mailing Address - Country:US
Mailing Address - Phone:205-792-8082
Mailing Address - Fax:
Practice Address - Street 1:154 MOUNT JOY AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-1425
Practice Address - Country:US
Practice Address - Phone:205-792-8082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010000133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered