Healthcare Provider Details

I. General information

NPI: 1598310336
Provider Name (Legal Business Name): KALIE ESPER RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2019
Last Update Date: 08/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4315 LONDONDERRY RD
HARRISBURG PA
17109-5318
US

IV. Provider business mailing address

875 S ARLINGTON AVE
HARRISBURG PA
17109-5004
US

V. Phone/Fax

Practice location:
  • Phone: 717-909-0290
  • Fax: 717-909-0292
Mailing address:
  • Phone: 717-652-1107
  • Fax: 717-652-1142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN005725
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: