Provider Demographics
NPI:1780228783
Name:ARMITAGE, KYAH F (LRD, RDN)
Entity Type:Individual
Prefix:
First Name:KYAH
Middle Name:F
Last Name:ARMITAGE
Suffix:
Gender:F
Credentials:LRD, RDN
Other - Prefix:
Other - First Name:KYAH
Other - Middle Name:F
Other - Last Name:LOEKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LRD, RDN
Mailing Address - Street 1:1461 BROADWAY N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-2622
Mailing Address - Country:US
Mailing Address - Phone:701-293-6037
Mailing Address - Fax:701-293-0242
Practice Address - Street 1:1461 BROADWAY N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-2622
Practice Address - Country:US
Practice Address - Phone:701-293-6037
Practice Address - Fax:701-293-0242
Is Sole Proprietor?:No
Enumeration Date:2019-11-01
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1114133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered