Diane Kopelakis, RD LD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

ND3420 Issued in FL

Practice address

7825 Nautique CT
Lake Worth, FL 33467-7791

Phone

(561) 436-6617

NPI assigned

Jan 20, 2023

Last updated

Jan 20, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 7

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

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

{
    "created_epoch": "1674172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674172800000",
    "number": "1093420325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7825 NAUTIQUE CT",
            "city": "LAKE WORTH",
            "state": "FL",
            "postal_code": "334677791",
            "telephone_number": "561-436-6617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7825 NAUTIQUE CT",
            "city": "LAKE WORTH",
            "state": "FL",
            "postal_code": "334677791",
            "telephone_number": "561-436-6617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOPELAKIS",
        "first_name": "DIANE",
        "credential": "RD LD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-01-20",
        "last_updated": "2023-01-20",
        "certification_date": "2023-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "FL",
            "license": "ND3420",
            "primary": true
        },
        {
            "code": "133VN1006X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Metabolic",
            "state": "FL",
            "license": "ND3420",
            "primary": false
        },
        {
            "code": "133VN1101X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Gerontological",
            "state": "FL",
            "license": "ND3420",
            "primary": false
        },
        {
            "code": "133VN1201X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Obesity and Weight Management",
            "state": "FL",
            "license": "ND3420",
            "primary": false
        },
        {
            "code": "133VN1501X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Sports Dietetics",
            "state": "FL",
            "license": "ND3420",
            "primary": false
        },
        {
            "code": "133N00000X",
            "taxonomy_group": "",
            "desc": "Nutritionist",
            "state": "FL",
            "license": "ND3420",
            "primary": false
        },
        {
            "code": "133NN1002X",
            "taxonomy_group": "",
            "desc": "Nutritionist, Nutrition, Education",
            "state": "FL",
            "license": "ND3420",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "USED LLC DOC # BC HAVE NO OTHER #",
            "identifier": "21000164980",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "diane@wellnessclarified.com",
            "affiliation": "N",
            "endpointDescription": "wc email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "home",
            "address_1": "7825 Nautique Court",
            "city": "Lake Worth",
            "state": "FL",
            "country_code": "US",
            "postal_code": "334677791",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Registered Dietitian in Lake Worth, FL
• Providers in Lake Worth, FL by specialty
• Registered Dietitian in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.