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General NPI Number Information
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NPI Number | 1003423625
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Entity Type | Individual
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Provider Name | KENRESE THERESA CARTER MS,CNS, LDN
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Gender | Female
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Dates
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Enumeration Date | 09/28/2020
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Last Update Date | 06/15/2025
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Provider Practice Location Address
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Address Line | 46088 SALTMARSH CT
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City | LEXINGTON PARK
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State | MD
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Zip | 20653-2879
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Country | US
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Telephone | 404-397-3009
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Fax |
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Provider Business Mailing Address
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Address Line | 4344 FAWN LN SE
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City | SMYRNA
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State | GA
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Zip | 30082-3951
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Country | US
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Telephone | 404-397-3009
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | ND14157
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | 164012155
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | DX5094
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License Number State | MD
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