Nicole Smith, RD, LD, CPHT

Primary specialty

Registered DietitianTaxonomy code 133V00000X

Practice address

500 E 5TH St
Fulton, MO 65251-1748

Phone

(573) 592-4100

NPI assigned

Nov 12, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Nicole Pastor Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1636675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636675200000",
    "number": "1114683281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 SHELLBARK DR",
            "city": "TROY",
            "state": "MO",
            "postal_code": "633793307",
            "telephone_number": "636-734-1430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 E 5TH ST",
            "city": "FULTON",
            "state": "MO",
            "postal_code": "652511748",
            "telephone_number": "573-592-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "NICOLE",
        "credential": "RD, LD, CPHT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-11-12",
        "last_updated": "2021-11-12",
        "certification_date": "2021-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183700000X",
            "taxonomy_group": "",
            "desc": "Pharmacy Technician",
            "state": "MO",
            "license": null,
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": "MO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "PASTOR",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kylie Elise Shumate, COTA/L
• Ella Simmons
• Katherine E Skibiski, PHYSICAL THERAPIST
• Erica Michelle Small, PA
• Anna Smart, LCSW
• Joan Maria Soltis, OT/L
• Karen L Souza, LCSW
• Thomas J Spencer, PSY D
• St of Mo Fulton St Hosp
• State of Missouri

• All providers in Fulton, MO
• Registered Dietitian in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2021; 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.