Provider Demographics
NPI:1194237511
Name:CORDER, ANGELA DENISE (MS, RDN, CSP, FAND)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:DENISE
Last Name:CORDER
Suffix:
Gender:F
Credentials:MS, RDN, CSP, FAND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 LAUREL CRK
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-1049
Mailing Address - Country:US
Mailing Address - Phone:864-940-5887
Mailing Address - Fax:
Practice Address - Street 1:407 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-2661
Practice Address - Country:US
Practice Address - Phone:888-765-3438
Practice Address - Fax:855-222-2815
Is Sole Proprietor?:No
Enumeration Date:2017-10-25
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004779133N00000X, 133V00000X
TN1431133N00000X, 133V00000X
GALD003427133V00000X
SC57133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist