Pamela J Nicholson, RD, LDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

164.000914 Issued in IL

Practice address

4500 Memorial Dr
Belleville, IL 62226-5360

Phone

(618) 257-4377

Fax

(618) 257-6616

NPI assigned

Dec 18, 2015

Last updated

Dec 18, 2015By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1450396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1450396800000",
    "number": "1033574967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 ELMBANK DR",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622264924",
            "telephone_number": "618-401-5361",
            "fax_number": "618-257-6616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 MEMORIAL DR",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622265360",
            "telephone_number": "618-257-4377",
            "fax_number": "618-257-6616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLSON",
        "first_name": "PAMELA",
        "middle_name": "J",
        "name_prefix": "Ms.",
        "credential": "RD, LDN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-12-18",
        "last_updated": "2015-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "IL",
            "license": "164.000914",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa Nicole Newgent, LCPC
• Nexus at Belleville, LLC
• Nexus Pavilion at Belleville, LLC
• Khai Ngo, MD
• Elizabeth Lee Nicholson, CRNA
• Joshua A. Niebruegge, M.D.
• Christopher Nier
• Jayne E. Ninness, LPTA
• Catherine Elizabeth Noble, M.D.
• Michael W Noble, D.M.D.

• Registered Dietitian in Belleville, IL
• Providers in Belleville, IL by specialty
• Registered Dietitian in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2015; 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.