Individual provider Active NPI

Stefanie Jean Wisse, RD

  • Registered Dietitian
  • Prosser, WA
National Provider Identifier
1073811998
Registry record updated Sep 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
DI60114384 Issued in WA
Practice address
820 Memorial St Ste 1
Prosser, WA 99350-2504
Phone
(509) 786-2010
Fax
(509) 788-1794
NPI assigned
Mar 1, 2011
Last updated
Sep 27, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X DI60114384 WA Primary

Addresses

Primary practice location

820 Memorial St Ste 1
Prosser, WA 99350-2504

Mailing address

820 Memorial St Ste 1
Prosser, WA 99350-2504
Phone (509) 786-2010

Other names 1

  • Ms. Stefanie Jean Herrington Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address swisse27437@yvfwc.direct-ci.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231218002968 WA Practitioner - Registered Dietitian Or Nutrition Professional 8820273717 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Registered Dietitian Or Nutrition Professional
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Yakima Valley Farm Workers ClinicGroup PAC ID 4385541986, 274 clinicians

Practice addresses (Care Compare)

1000 Wallace Way
Grandview, WA 98930-8805
Phone (509) 882-3444

713 Memorial St
Prosser, WA 99350-1524
Phone (509) 788-0485

820 Memorial St
Suite 1
Prosser, WA 99350-2504
Phone (509) 786-2010

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DI60114384WAMDRegistered Dietitian
21973CAMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Yakima Valley Farm Workers Clinic Current Accepting new patients
Yakima Valley Farm Workers Clinic CurrentSince Oct 22, 2023 Accepting new patients
Yakima Valley Farm Workers Clinic CurrentSince Oct 22, 2023 Accepting new patients

Locations

1000 Wallace Way
Grandview, WA 98930
Phone (509) 788-1702

713 Memorial St
Prosser, WA 99350
Phone (509) 786-1931

820 Memorial St
Ste 1
Prosser, WA 99350
Phone (509) 504-5300

3801 Kern Rd
Yakima, WA 98902
Phone (509) 574-3200

Organizations & group practices 3

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": "1298937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695772800000",
    "number": "1073811998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 MEMORIAL ST STE 1",
            "city": "PROSSER",
            "state": "WA",
            "postal_code": "993502504",
            "telephone_number": "509-786-2010",
            "fax_number": "509-788-1794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 MEMORIAL ST STE 1",
            "city": "PROSSER",
            "state": "WA",
            "postal_code": "993502504",
            "telephone_number": "509-786-2010",
            "fax_number": "509-788-1794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISSE",
        "first_name": "STEFANIE",
        "middle_name": "JEAN",
        "name_prefix": "Mrs.",
        "credential": "RD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-01",
        "last_updated": "2023-09-27",
        "certification_date": "2023-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "WA",
            "license": "DI60114384",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "swisse27437@yvfwc.direct-ci.com",
            "affiliation": "N",
            "endpointDescription": "YVFWC Direct Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "820 Memorial St Ste 1",
            "city": "Prosser",
            "state": "WA",
            "country_code": "US",
            "postal_code": "993502504",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "STEFANIE",
            "last_name": "HERRINGTON",
            "middle_name": "JEAN",
            "prefix": "MS.",
            "credential": "RD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Prosser, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.