MEDICARE: KERRY MCFADDEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133N00000X	Nutritionist

General Provider Information

NPI Number	:	1285344176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERRY MCFADDEN

Provider Business Mailing Address
First Line	:	2662 JULIAN ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-4023
Country	:	US
Telephone Number	:	720-633-3639
Fax Number	:

Provider Business Practice Location Address
First Line	:	2662 JULIAN ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-4023
Country	:	US
Telephone Number	:	720-633-3639
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2022
Last Update Date	:	12/01/2022

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Directions to “ KERRY MCFADDEN ” Practice Location

Language	Start Address	Practice Location

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