Provider Demographics
NPI:1295081594
Name:HERRING, SANDI KELLER (RD, LD, CDE)
Entity type:Individual
Prefix:MRS
First Name:SANDI
Middle Name:KELLER
Last Name:HERRING
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:MISS
Other - First Name:SANDI
Other - Middle Name:LYNN
Other - Last Name:KELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:3500 LAKELAND DR STE 517
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-3017
Mailing Address - Country:US
Mailing Address - Phone:601-932-2140
Mailing Address - Fax:601-510-9009
Practice Address - Street 1:3500 LAKELAND DR STE 517
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-3017
Practice Address - Country:US
Practice Address - Phone:601-932-2140
Practice Address - Fax:601-510-9009
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSD0831133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered