Provider Demographics
NPI:1043033491
Name:KEMISH, KERI A (RD, CDN)
Entity type:Individual
Prefix:
First Name:KERI
Middle Name:A
Last Name:KEMISH
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:643 FOUR ROD RD
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06037-2279
Mailing Address - Country:US
Mailing Address - Phone:860-543-9071
Mailing Address - Fax:
Practice Address - Street 1:643 FOUR ROD RD
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:CT
Practice Address - Zip Code:06037-2279
Practice Address - Country:US
Practice Address - Phone:860-543-9071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT895243133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered