Healthcare Provider Details

I. General information

NPI: 1598384117
Provider Name (Legal Business Name): CAROLINE KERN MS, RDN, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2020
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 IRVING ST NW
WASHINGTON DC
20010-3017
US

IV. Provider business mailing address

936 BAY RIDGE AVE UNIT 301
ANNAPOLIS MD
21403-3144
US

V. Phone/Fax

Practice location:
  • Phone: 903-908-3560
  • Fax:
Mailing address:
  • Phone: 903-908-3560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86052422
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDX4515
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License NumberDI100001031
License Number StateDC
# 4
Primary TaxonomyN
Taxonomy Code133VN1301X
TaxonomyOncology Nutrition Registered Dietitian
License NumberDI100001031
License Number StateDC
# 5
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI100001031
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: