Healthcare Provider Details

I. General information

NPI: 1336394402
Provider Name (Legal Business Name): MYERLY KERTIS M.S., R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2008
Last Update Date: 11/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW. 12TH AVE NUTRITION SERVICES/ JACKSON MEMORIAL HOSPITAL
MIAMI FL
33136-1096
US

IV. Provider business mailing address

2016 BAY DR #506
MIAMI BEACH FL
33141-4436
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-5298
  • Fax:
Mailing address:
  • Phone: 305-866-1813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND3578
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: