Provider Demographics
NPI:1447036181
Name:LEE, KERRY (RDN)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:LEE
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 1:20324 BOTHELL EVERETT HWY APT F302
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-7140
Mailing Address - Country:US
Mailing Address - Phone:214-714-1912
Mailing Address - Fax:
Practice Address - Street 1:20324 BOTHELL EVERETT HWY APT F302
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-7140
Practice Address - Country:US
Practice Address - Phone:214-714-1912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-07
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA86118870133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered