Provider Demographics
NPI:1083287890
Name:HART, MEKAYLA (RD, RDN)
Entity Type:Individual
Prefix:
First Name:MEKAYLA
Middle Name:
Last Name:HART
Suffix:
Gender:F
Credentials:RD, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-2345
Mailing Address - Country:US
Mailing Address - Phone:304-529-4217
Mailing Address - Fax:
Practice Address - Street 1:1101 6TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-2345
Practice Address - Country:US
Practice Address - Phone:304-399-0225
Practice Address - Fax:304-523-6051
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.09383133V00000X
WV1025133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered