MEDICARE: KERRI K DOUCETTE R.N., R.D., C.D.E.

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	133V00000X	Registered Dietitian	L003934	NC
2	163WD0400X	Diabetes Educator Registered Nurse	97278	NC

General Provider Information

NPI Number	:	1386778066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERRI K DOUCETTE R.N., R.D., C.D.E.

Provider Business Mailing Address
First Line	:	20218 COLONY POINT LN
Second Line	:
City	:	CORNELIUS
State	:	NC
Zip	:	28031-6011
Country	:	US
Telephone Number	:	603-361-9620
Fax Number	:

Provider Business Practice Location Address
First Line	:	20218 COLONY POINT LN
Second Line	:
City	:	CORNELIUS
State	:	NC
Zip	:	28031-6011
Country	:	US
Telephone Number	:	603-361-9620
Fax Number	:

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

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	02/27/2012

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