Active NPI
Kenrese Theresa Carter, MS,CNS, LDN
- Nutritionist
- Lexington Park, MD
National Provider Identifier
1003423625
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nutritionist
- License
- DX5094
- Practice address
- 46088 Saltmarsh CT
Lexington Park, MD 20653-2879 - Phone
- (404) 397-3009
- NPI assigned
- Sep 28, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nutritionist | 133N00000X | ND14157 | FL | |
| Nutritionist | 133N00000X | 164012155 | IL | |
| Nutritionist | 133N00000X | DX5094 | MD | Primary |
Addresses
Primary practice location
46088 Saltmarsh CT
Lexington Park, MD 20653-2879
Mailing address
4344 Fawn LN SE
Smyrna, GA 30082-3951
Phone (404) 397-3009
Other practice location 1
6537 SW 26th Ct
Miramar, FL 33023-3810
Phone (404) 397-3009
Other names 1
- Kenrese Theresa Campbell
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Certified Nurse Specialist, Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ND14157 | FL | MD | Nutritionist |
| 164012155 | IL | MD | Nutritionist |
| DX5094 | MD | MD | Nutritionist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1601251200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1749945600000",
"number": "1003423625",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4344 FAWN LN SE",
"city": "SMYRNA",
"state": "GA",
"postal_code": "300823951",
"telephone_number": "404-397-3009"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "46088 SALTMARSH CT",
"city": "LEXINGTON PARK",
"state": "MD",
"postal_code": "206532879",
"telephone_number": "404-397-3009"
}
],
"practiceLocations": [
{
"address_1": "6537 SW 26th Ct",
"address_purpose": "LOCATION",
"city": "Miramar",
"state": "FL",
"postal_code": "330233810",
"country_code": "US",
"telephone_number": "404-397-3009",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CARTER",
"first_name": "KENRESE",
"middle_name": "THERESA",
"credential": "MS,CNS, LDN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-09-28",
"last_updated": "2025-06-15",
"certification_date": "2025-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "133N00000X",
"taxonomy_group": "",
"desc": "Nutritionist",
"state": "FL",
"license": "ND14157",
"primary": false
},
{
"code": "133N00000X",
"taxonomy_group": "",
"desc": "Nutritionist",
"state": "IL",
"license": "164012155",
"primary": false
},
{
"code": "133N00000X",
"taxonomy_group": "",
"desc": "Nutritionist",
"state": "MD",
"license": "DX5094",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KENRESE",
"last_name": "CAMPBELL",
"middle_name": "THERESA",
"credential": "MS, CNS, LDN",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Lexington Park, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.