Active NPI
Kimberly Johnson, RD
- Registered Dietitian
- Lauderdale by the Sea, FL
National Provider Identifier
1114665395
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 10842
- Practice address
- 4213 El Mar Dr Apt 4
Lauderdale by the Sea, FL 33308-5420 - Phone
- (918) 630-1578
- NPI assigned
- May 26, 2022
- Sex
- Female
- Sole proprietor
- No
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 | 10842 | FL | Primary |
Addresses
Primary practice location
4213 El Mar Dr Apt 4
Lauderdale by the Sea, FL 33308-5420
Mailing address
4213 El Mar Dr Apt 4
Lauderdale by the Sea, FL 33308-5420
Phone (918) 630-1578
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10842 | FL | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dietitian Group Corporation | Current | Accepting new patients | |
| Nourish, Inc. | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Nutritionist
- Boca Raton, FL
- NPI 1093312381
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1653523200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1654473600000",
"number": "1114665395",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4213 EL MAR DR APT 4",
"city": "LAUDERDALE BY THE SEA",
"state": "FL",
"postal_code": "333085420",
"telephone_number": "918-630-1578"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4213 EL MAR DR APT 4",
"city": "LAUDERDALE BY THE SEA",
"state": "FL",
"postal_code": "333085420",
"telephone_number": "918-630-1578"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "KIMBERLY",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-05-26",
"last_updated": "2022-06-06",
"certification_date": "2022-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "FL",
"license": "10842",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lauderdale by the Sea, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2022; 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.