Provider Demographics
NPI:1508520081
Name:MYATT, MEGHAN (RD)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:MYATT
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 1:20972 W EASTVIEW WAY
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85396-1597
Mailing Address - Country:US
Mailing Address - Phone:602-430-1073
Mailing Address - Fax:
Practice Address - Street 1:20972 W EASTVIEW WAY
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85396-1597
Practice Address - Country:US
Practice Address - Phone:602-430-1073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
997077OtherCOMMISSION ON DIETETIC REGISTRATION