NPIMap

Organization Active NPI

MK-Rdnutrition

  • Registered Dietitian
  • Las Vegas, NV
National Provider Identifier
1124553375
Registry record updated Sep 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
32302D1-0 Issued in NV
Legal business name
MK-RDNUTRITION
Practice address
6040 S Fort Apache Rd
Suite #100
Las Vegas, NV 89148-5655
Phone
(702) 781-2577
NPI assigned
Apr 25, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2024

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

Authorized official

Name
Michelle Konstantarakis, R.D.
Title
President
Phone
(702) 589-1414

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered DietitianGroup: 193400000X SINGLE SPECIALTY GROUP 133V00000X 32302D1-0 NV Primary

Addresses

Primary practice location

6040 S Fort Apache Rd
Suite #100
Las Vegas, NV 89148-5655

Mailing address

6040 S Fort Apache Rd Ste 100
Las Vegas, NV 89148-5613
Phone (702) 475-4007

Other identifiers 1

IdentifierTypeStateIssuer
32302D1-0OtherNVNV DIETITIAN LICENSE

Other names 1

  • CREATING A NEW NORM Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170616001115 NV Part B Supplier - Clinic/Group Practice 1951679893 Receives reassigned benefits from 7 practitioners
Practice locations: Las Vegas, NV

National Provider Directory

National Provider Directory

Locations

6040 S Fort Apache Rd
Ste 100
Las Vegas, NV 89148
Phone (702) 475-4007

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1493078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725235200000",
    "number": "1124553375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6040 S FORT APACHE RD STE 100",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891485613",
            "telephone_number": "702-475-4007",
            "fax_number": "702-475-4060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6040 S FORT APACHE RD",
            "address_2": "SUITE #100",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891485655",
            "telephone_number": "702-781-2577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MK-RDNUTRITION",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-25",
        "last_updated": "2024-09-02",
        "certification_date": "2024-09-02",
        "status": "A",
        "authorized_official_last_name": "KONSTANTARAKIS",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "702-589-1414",
        "authorized_official_credential": "R.D."
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": "NV",
            "license": "32302D1-0",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NV DIETITIAN LICENSE",
            "identifier": "32302D1-0",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CREATING A NEW NORM",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2024; 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.