Provider Demographics
NPI:1053378372
Name:MORELAND, PAMELA JEAN (RD)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:JEAN
Last Name:MORELAND
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 1:10641 IVY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BENT MOUNTAIN
Mailing Address - State:VA
Mailing Address - Zip Code:24059-2137
Mailing Address - Country:US
Mailing Address - Phone:540-588-2353
Mailing Address - Fax:
Practice Address - Street 1:3501 COLONIAL GREEN CIR SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-3752
Practice Address - Country:US
Practice Address - Phone:540-344-3276
Practice Address - Fax:540-342-4399
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD000333133V00000X
133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered