Healthcare Provider Details

I. General information

NPI: 1063423192
Provider Name (Legal Business Name): KERRY L PERKINS LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KERRY L FOX

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 10/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SCHOOLHOUSE RD
MIDDLETOWN PA
17057-3548
US

IV. Provider business mailing address

PO BOX 858 MC A410
HERSHEY PA
17033-0858
US

V. Phone/Fax

Practice location:
  • Phone: 800-243-1455
  • Fax:
Mailing address:
  • Phone: 800-243-1455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN003532
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: