Provider Demographics
NPI:1649494501
Name:MILLARD, HEATHER KRISTIN (RD)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:KRISTIN
Last Name:MILLARD
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 1:5209 AUTUMN MEADOW AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-7012
Mailing Address - Country:US
Mailing Address - Phone:702-267-7580
Mailing Address - Fax:
Practice Address - Street 1:531 N 30TH ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-3650
Practice Address - Country:US
Practice Address - Phone:702-385-5284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV920422133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered