Active NPI
Kerry Green, MS, RD, LD
- Registered Dietitian
- Boerne, TX
National Provider Identifier
1598076135
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- DT04664
- Practice address
- 265 N Main St Ste B
Boerne, TX 78006-2044 - Phone
- (210) 415-0165
- NPI assigned
- Jun 29, 2010
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | DT04664 | TX | Primary |
Addresses
Primary practice location
265 N Main St Ste B
Boerne, TX 78006-2044
Mailing address
265 N Main St Ste B
Boerne, TX 78006-2044
Phone (210) 415-0165
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)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DT04664 | TX | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1277769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1299801600000",
"number": "1598076135",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "265 N MAIN ST STE B",
"city": "BOERNE",
"state": "TX",
"postal_code": "780062044",
"telephone_number": "210-415-0165"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "265 N MAIN ST STE B",
"city": "BOERNE",
"state": "TX",
"postal_code": "780062044",
"telephone_number": "210-415-0165"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "KERRY",
"name_prefix": "Mrs.",
"credential": "MS, RD, LD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-06-29",
"last_updated": "2011-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "TX",
"license": "DT04664",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boerne, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.