Provider Demographics
NPI:1669800454
Name:HARGIS, KEITH (RD,LD)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:HARGIS
Suffix:
Gender:M
Credentials:RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 N EISENHOWER AVE
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-1525
Mailing Address - Country:US
Mailing Address - Phone:641-428-7799
Mailing Address - Fax:641-428-5274
Practice Address - Street 1:910 N EISENHOWER AVE
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-1552
Practice Address - Country:US
Practice Address - Phone:641-428-7799
Practice Address - Fax:641-428-5274
Is Sole Proprietor?:No
Enumeration Date:2013-10-15
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001919133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered