Provider Demographics
NPI:1003385196
Name:HARRYMAN, SALLY ANN (RD)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:ANN
Last Name:HARRYMAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 E MCKAY ST
Mailing Address - Street 2:
Mailing Address - City:FRONTENAC
Mailing Address - State:KS
Mailing Address - Zip Code:66763-2247
Mailing Address - Country:US
Mailing Address - Phone:620-240-3416
Mailing Address - Fax:
Practice Address - Street 1:314 E MCKAY ST
Practice Address - Street 2:
Practice Address - City:FRONTENAC
Practice Address - State:KS
Practice Address - Zip Code:66763-2247
Practice Address - Country:US
Practice Address - Phone:620-240-3416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00OtherI DO NOT HAVE ANY OTHER IDENTIFIERS