Active NPI
Cassidy Renee Fowler
- Registered Dietitian
- Valparaiso, IN
National Provider Identifier
1053015701
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 37003682A
- Practice address
- 2401 Valley Dr
Valparaiso, IN 46383-2520 - Phone
- (219) 462-7173
- NPI assigned
- Mar 28, 2023
- 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 | 37003682A | IN | Primary |
Addresses
Primary practice location
2401 Valley Dr
Valparaiso, IN 46383-2520
Mailing address
222 Roberta Ave
Michigan City, IN 46360-5950
Phone (219) 809-7480
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 |
|---|---|---|---|
| 37003682A | IN | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1679961600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1679961600000",
"number": "1053015701",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "222 ROBERTA AVE",
"city": "MICHIGAN CITY",
"state": "IN",
"postal_code": "463605950",
"telephone_number": "219-809-7480"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2401 VALLEY DR",
"city": "VALPARAISO",
"state": "IN",
"postal_code": "463832520",
"telephone_number": "219-462-7173"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FOWLER",
"first_name": "CASSIDY",
"middle_name": "RENEE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-03-28",
"last_updated": "2023-03-28",
"certification_date": "2023-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IN",
"license": "37003682A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Valparaiso, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.