Healthcare Provider Details

I. General information

NPI: 1386778066
Provider Name (Legal Business Name): KERRI K DOUCETTE R.N., R.D., C.D.E.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KERRI A KULCH R.D., L.D.N.

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 02/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20218 COLONY POINT LN
CORNELIUS NC
28031-6011
US

IV. Provider business mailing address

20218 COLONY POINT LN
CORNELIUS NC
28031-6011
US

V. Phone/Fax

Practice location:
  • Phone: 603-361-9620
  • Fax:
Mailing address:
  • Phone: 603-361-9620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL003934
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number97278
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: