MEDICARE: MS. RACHEL MARIE HART RDN, LD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	121374	IA
2	133V00000X	Registered Dietitian	DT83976	TX

General Provider Information

NPI Number	:	1376224063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RACHEL MARIE HART RDN, LD

Provider Business Mailing Address
First Line	:	3200 SANDAGE AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-2353
Country	:	US
Telephone Number	:	614-315-7814
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 SANDAGE AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-2353
Country	:	US
Telephone Number	:	614-315-7814
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2023
Last Update Date	:	07/26/2023

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