Active NPI
Kimberly Ann Russo, MA, RD, LDN
- Registered Dietitian
- Trappe, PA
National Provider Identifier
1083477251
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- DN001138
- Practice address
- 180 Joan Dr
Trappe, PA 19426-1957 - Phone
- (610) 304-7174
- NPI assigned
- Jan 31, 2024
- Last updated
- Jan 31, 2024
- Sex
- Female
- Sole proprietor
- Yes
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 | DN001138 | PA | Primary |
Addresses
Primary practice location
180 Joan Dr
Trappe, PA 19426-1957
Mailing address
180 Joan Dr
Trappe, PA 19426-1957
Phone (610) 304-7174
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN001138 | PA | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fay Nutrition | 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": "1706659200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1706659200000",
"number": "1083477251",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "180 JOAN DR",
"city": "TRAPPE",
"state": "PA",
"postal_code": "194261957",
"telephone_number": "610-304-7174"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "180 JOAN DR",
"city": "TRAPPE",
"state": "PA",
"postal_code": "194261957",
"telephone_number": "610-304-7174"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSO",
"first_name": "KIMBERLY",
"middle_name": "ANN",
"credential": "MA, RD, LDN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-01-31",
"last_updated": "2024-01-31",
"certification_date": "2024-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "PA",
"license": "DN001138",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Trappe, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.