Renny Samuel-Worsham, M.S.,R.D.,L.D.

Primary specialty

Renal Nutrition Registered DietitianTaxonomy code 133VN1005X

License

DT01379 Issued in TX

Practice address

4204 Gardendale St
Ste 106
San Antonio, TX 78229-3138

Phone

(210) 325-0147

NPI assigned

Dec 25, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

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

{
    "created_epoch": "1198540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592956800000",
    "number": "1104000298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 S INWOOD HEIGHTS DR",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782481684",
            "telephone_number": "210-408-7223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4204 GARDENDALE ST",
            "address_2": "STE 106",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782293138",
            "telephone_number": "210-325-0147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMUEL-WORSHAM",
        "first_name": "RENNY",
        "name_prefix": "Mrs.",
        "credential": "M.S.,R.D.,L.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-12-25",
        "last_updated": "2020-06-24",
        "certification_date": "2020-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133VN1005X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Renal",
            "state": "TX",
            "license": "DT01379",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Renal Nutrition Registered Dietitian in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Renal Nutrition Registered Dietitian in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2020; 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.