Healthcare Provider Details

I. General information

NPI: 1780598292
Provider Name (Legal Business Name): TARA HARMAN KELLY PHD, RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 COLLEY AVE
NORFOLK VA
23507-1627
US

IV. Provider business mailing address

2101 GOVERNORS POINTE DR
SUFFOLK VA
23436-1132
US

V. Phone/Fax

Practice location:
  • Phone: 757-446-7063
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86038850
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: