The Fresh Beet Nutrition LLC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

Legal business name

THE FRESH BEET NUTRITION LLC

Practice address

1609 W Moss Ave
Peoria, IL 61606-1642

Phone

(843) 410-8233

NPI assigned

Jan 15, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ashley G Thomas, MS, RD

Title

Registered Dietitian/Owner

Phone

(843) 410-8233

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1547510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1547510400000",
    "number": "1003380866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1609 W MOSS AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616061642",
            "telephone_number": "843-410-8233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1609 W MOSS AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616061642",
            "telephone_number": "843-410-8233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE FRESH BEET NUTRITION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-15",
        "last_updated": "2019-01-15",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "ASHLEY",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "REGISTERED DIETITIAN/OWNER",
        "authorized_official_telephone_number": "843-410-8233",
        "authorized_official_credential": "MS, RD"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DT1129",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.