Active NPI
Krista Clark
- Registered Dietitian
- West Chester, OH
National Provider Identifier
1073048567
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- LD4510
- Practice address
- 7700 University Dr
Fans
West Chester, OH 45069-2505 - Phone
- (513) 298-3649
- NPI assigned
- Apr 22, 2017
- Last updated
- Apr 22, 2017
- 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 | LD4510 | OH | Primary |
Addresses
Primary practice location
7700 University Dr
Fans
West Chester, OH 45069-2505
Mailing address
7700 University Dr
Fans
West Chester, OH 45069-2505
Phone (513) 298-3649
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 |
|---|---|---|---|
| LD4510 | OH | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nourish, Inc. | Dietitian, Registered | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1492819200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1492819200000",
"number": "1073048567",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7700 UNIVERSITY DR",
"address_2": "FANS",
"city": "WEST CHESTER",
"state": "OH",
"postal_code": "450692505",
"telephone_number": "513-298-3649"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7700 UNIVERSITY DR",
"address_2": "FANS",
"city": "WEST CHESTER",
"state": "OH",
"postal_code": "450692505",
"telephone_number": "513-298-3649"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "KRISTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-04-22",
"last_updated": "2017-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "OH",
"license": "LD4510",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Chester, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.