Active NPI
Mandy Johnson, MS, RD, LD
- Registered Dietitian
- El Paso, TX
National Provider Identifier
1003481854
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- DT86920
- Practice address
- 415 S Mesa Hills Dr Apt 1142
El Paso, TX 79912-5484 - Phone
- (915) 861-9119
- NPI assigned
- May 24, 2021
- Sex
- Female
- Sole proprietor
- Yes
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 | DT86920 | TX | Primary |
Addresses
Primary practice location
415 S Mesa Hills Dr Apt 1142
El Paso, TX 79912-5484
Mailing address
415 S Mesa Hills Dr Apt 1142
El Paso, TX 79912-5484
Phone (915) 861-9119
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DT86920 | TX | MD | Registered Dietitian |
Practice roles (1 of 3)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nourish, Inc. | Dietitian, Registered | Past | Accepting new patients |
Networks
- TX HMO D-SNP
- TX HMO
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1621814400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1621814400000",
"number": "1003481854",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "415 S MESA HILLS DR APT 1142",
"city": "EL PASO",
"state": "TX",
"postal_code": "799125484",
"telephone_number": "915-861-9119"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "415 S MESA HILLS DR APT 1142",
"city": "EL PASO",
"state": "TX",
"postal_code": "799125484",
"telephone_number": "915-861-9119"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "MANDY",
"credential": "MS, RD, LD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-05-24",
"last_updated": "2021-05-24",
"certification_date": "2021-05-24",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dietitian, Registered",
"state": "TX",
"license": "DT86920",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in El Paso, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.