Active NPI
Amanda Hagedorn, RD, LD, CLC
- Registered Dietitian
- Saint Louis, MO
National Provider Identifier
1124882162
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86038663
- Practice address
- 9511 Hale Dr
Saint Louis, MO 63123-5507 - Phone
- (314) 805-3173
- NPI assigned
- Feb 9, 2024
- 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 | 86038663 | MO | Primary |
Addresses
Primary practice location
9511 Hale Dr
Saint Louis, MO 63123-5507
Mailing address
9511 Hale Dr
Saint Louis, MO 63123-5507
Phone (314) 805-3173
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Bachelor of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86038663 | MO | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1707436800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1707436800000",
"number": "1124882162",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9511 HALE DR",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631235507",
"telephone_number": "314-805-3173"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9511 HALE DR",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631235507",
"telephone_number": "314-805-3173"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAGEDORN",
"first_name": "AMANDA",
"credential": "RD, LD, CLC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-02-09",
"last_updated": "2024-02-09",
"certification_date": "2024-02-09",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MO",
"license": "86038663",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.