Provider Demographics
NPI:1801876529
Name:HARVILL, ANGELA KAY (RD, LN)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:KAY
Last Name:HARVILL
Suffix:
Gender:F
Credentials:RD, LN
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:KAY
Other - Last Name:BRISCOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LDN
Mailing Address - Street 1:2400 S ROOSEVELT CIR
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-3200
Mailing Address - Country:US
Mailing Address - Phone:605-271-1428
Mailing Address - Fax:
Practice Address - Street 1:9501 FARRELL RD
Practice Address - Street 2:
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060-5901
Practice Address - Country:US
Practice Address - Phone:703-805-0790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0348133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered