Healthcare Provider Details

I. General information

NPI: 1801876529
Provider Name (Legal Business Name): ANGELA KAY HARVILL RD, LN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA KAY BRISCOE RD, LDN

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9501 FARRELL RD
FORT BELVOIR VA
22060-5901
US

IV. Provider business mailing address

2400 S ROOSEVELT CIR
SIOUX FALLS SD
57106-3200
US

V. Phone/Fax

Practice location:
  • Phone: 703-805-0790
  • Fax:
Mailing address:
  • Phone: 605-271-1428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number0348
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: