Active NPI
Amanda Marie Reilson, RD, LDN
- Registered Dietitian
- Maryville, IL
National Provider Identifier
1003067422
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 164004969
- Practice address
- 6800 State Route 162
Maryville, IL 62062-8500 - Phone
- (618) 391-5528
- Fax
- (618) 288-3638
- NPI assigned
- Oct 3, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 164004969 | IL | Primary |
Addresses
Primary practice location
6800 State Route 162
Maryville, IL 62062-8500
Mailing address
1813 Marine Rd
Saint Jacob, IL 62281-1243
Phone (618) 644-3129
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 164004969 | IL | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1222992000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1255478400000",
"number": "1003067422",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1813 MARINE RD",
"city": "SAINT JACOB",
"state": "IL",
"postal_code": "622811243",
"telephone_number": "618-644-3129"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6800 STATE ROUTE 162",
"city": "MARYVILLE",
"state": "IL",
"postal_code": "620628500",
"telephone_number": "618-391-5528",
"fax_number": "618-288-3638"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REILSON",
"first_name": "AMANDA",
"middle_name": "MARIE",
"name_prefix": "Mrs.",
"credential": "RD, LDN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-10-03",
"last_updated": "2009-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IL",
"license": "164004969",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Maryville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.