Healthcare Provider Details

I. General information

NPI: 1477580470
Provider Name (Legal Business Name): ANN KELLER HOOVER R. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 ROANOKE BLVD NUTRITION SERVICE (#120)
SALEM VA
24153-6404
US

IV. Provider business mailing address

1970 ROANOKE BLVD NUTRITION SERVICE (#120)
SALEM VA
24153-6404
US

V. Phone/Fax

Practice location:
  • Phone: 540-982-2463
  • Fax: 540-983-1059
Mailing address:
  • Phone: 540-982-2463
  • Fax: 540-983-1059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number712204
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: