Misty Mullins Clackum, RD, CSP, LDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

LD002340 Issued in GA

Practice address

1814 Treesort VW
Gainesville, GA 30506-5383

Phone

(423) 284-5512

Fax

(770) 470-0770

NPI assigned

Dec 11, 2013

Last updated

Jul 26, 2025By 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 4

Addresses

Other identifiers 1

Other names 1

• Misty Lehe Mullins Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Misty Clackum Nutrition LLC

  • Registered Dietitian
  • Gainesville, GA
  • NPI 1467335786

  Dietitian, Registered

  NPD Authorized official
• Fay Nutrition

  • Registered Dietitian
  • San Francisco, CA
  • NPI 1104334465

  Dietitian, Registered

  NPD (past)
• Nourish, Inc.

  • Registered Dietitian
  • Austin, TX
  • NPI 1558097824

  Dietitian, Registered

  NPD (past)

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

{
    "created_epoch": "1386720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753488000000",
    "number": "1073944492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1814 TREESORT VW",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305065383",
            "telephone_number": "423-284-5512",
            "fax_number": "770-470-0770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1814 TREESORT VW",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305065383",
            "telephone_number": "423-284-5512",
            "fax_number": "770-470-0770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLACKUM",
        "first_name": "MISTY",
        "middle_name": "MULLINS",
        "name_prefix": "Mrs.",
        "credential": "RD, CSP, LDN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-12-11",
        "last_updated": "2025-07-26",
        "certification_date": "2025-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "GA",
            "license": "LD002340",
            "primary": true
        },
        {
            "code": "133VN1004X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Pediatric",
            "state": "TN",
            "license": "1250",
            "primary": false
        },
        {
            "code": "133VN1004X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Pediatric",
            "state": "GA",
            "license": "LD002340",
            "primary": false
        },
        {
            "code": "133VN1401X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Pediatric Critical Care",
            "state": "GA",
            "license": "LD002340",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q038482",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MISTY",
            "last_name": "MULLINS",
            "middle_name": "LEHE",
            "credential": "RD, CSP, LDN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sorin George Circa, PA
• Rudolf W Cisco, DPM
• Isabel Annaly Cisneros
• City of Gainesville (Community Service Center)
• Nathan Drew City, D.O.
• Carrie Leigh Clark, MS, PT
• Hailey Clark
• Kara Schneider Clark, FNP-C
• Lillee Clark, PH.D.
• Mark D Clark, FNP

• Registered Dietitian in Gainesville, GA
• Providers in Gainesville, GA by specialty
• Registered Dietitian in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2025; 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.