Healthcare Provider Details

I. General information

NPI: 1306261276
Provider Name (Legal Business Name): HEATHER HUNT NAGY MS, RD, LD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2014
Last Update Date: 02/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3098 OAK GROVE ROAD REGIONAL PHYSICIAN SPECIALISTS: BARIATRIC SURGERY
POPLAR BLUFF MO
63901-3098
US

IV. Provider business mailing address

3098 OAK GROVE ROAD REGIONAL PHYSICIAN SPECIALISTS: BARIATRIC SURGERY
POPLAR BLUFF MO
63901-3098
US

V. Phone/Fax

Practice location:
  • Phone: 573-776-9911
  • Fax: 573-776-9913
Mailing address:
  • Phone: 573-776-9911
  • Fax: 573-776-9913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2000172881
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: