St. Louis Department of Veterans Affairs

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

2009000717 Issued in MO

Legal business name

ST. LOUIS DEPARTMENT OF VETERANS AFFAIRS

Practice address

1 Jefferson Barracks Dr
Saint Louis, MO 63125-4181

Phone

(314) 652-4100

NPI assigned

Feb 7, 2011

Organization subpart

No

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

Authorized official

Name

Mrs. Brooke Marie Theodorakos, M.S., R.D., L.D.

Title

Registered Dietitian

Phone

(314) 652-4100

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1297036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297036800000",
    "number": "1033415112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 JEFFERSON BARRACKS DR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631254181",
            "telephone_number": "314-652-4100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 JEFFERSON BARRACKS DR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631254181",
            "telephone_number": "314-652-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. LOUIS DEPARTMENT OF VETERANS AFFAIRS",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-07",
        "last_updated": "2011-02-07",
        "status": "A",
        "authorized_official_last_name": "THEODORAKOS",
        "authorized_official_first_name": "BROOKE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "REGISTERED DIETITIAN",
        "authorized_official_telephone_number": "314-652-4100",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "M.S., R.D., L.D."
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": "MO",
            "license": "2009000717",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Registered Dietitian in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Registered Dietitian in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2011; 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.