MEDICARE: MEREDITH HEARD RD

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	11097	OH

General Provider Information

NPI Number	:	1821977844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEREDITH HEARD RD

Provider Business Mailing Address
First Line	:	4879 US HIGHWAY 68 S
Second Line	:
City	:	WEST LIBERTY
State	:	OH
Zip	:	43357-3501
Country	:	US
Telephone Number	:	937-599-1411
Fax Number	:

Provider Business Practice Location Address
First Line	:	4879 US HIGHWAY 68 S
Second Line	:
City	:	WEST LIBERTY
State	:	OH
Zip	:	43357-3501
Country	:	US
Telephone Number	:	937-599-1411
Fax Number	:

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

Provider Enumeration Date	:	09/02/2025
Last Update Date	:	05/05/2026

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