Healthcare Provider Details

I. General information

NPI: 1437754330
Provider Name (Legal Business Name): MILESTONES PEDIATRIC & MATERNAL NUTRITION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2020
Last Update Date: 11/01/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 KILDAIRE FARM RD
CARY NC
27511-3433
US

IV. Provider business mailing address

417 KILDAIRE FARM RD
CARY NC
27511-3433
US

V. Phone/Fax

Practice location:
  • Phone: 919-443-5240
  • Fax: 919-899-0667
Mailing address:
  • Phone: 919-443-5240
  • Fax: 919-899-0667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name: KERRY MARIE LETT
Title or Position: REGISTERED DIETITIAN & CEO
Credential: MPH, RDN, LDN, CLC
Phone: 919-443-5240