=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578183620
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RYAN D HALL DCN,CNS, LDN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2020
-----------------------------------------------------
Last Update Date | 03/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2071 AFTON MOUNTAIN RD
-----------------------------------------------------
City | AFTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22920-2308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-326-8635
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2071 AFTON MOUNTAIN RD
-----------------------------------------------------
City | AFTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22920-2308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-326-8635
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133N00000X
-----------------------------------------------------
Taxonomy Name | Nutritionist
-----------------------------------------------------
License Number | 17913
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 133N00000X
-----------------------------------------------------
Taxonomy Name | Nutritionist
-----------------------------------------------------
License Number | DX5865
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------