Divine Nutrition Service

Primary specialty

Registered DietitianTaxonomy code 133V00000X

Legal business name

DIVINE NUTRITION SERVICE

Practice address

2080 Cordoba Dr
Florissant, MO 63033-2807

Phone

(314) 732-2302

NPI assigned

Jun 1, 2017

Last updated

Feb 3, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Michelle Genene Hamilton, RDLD

Title

Owner/Executive Director

Phone

(314) 732-2302

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1496275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612310400000",
    "number": "1134657208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2080 CORDOBA DR",
            "city": "FLORISSANT",
            "state": "MO",
            "postal_code": "630332807",
            "telephone_number": "314-732-2302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2080 CORDOBA DR",
            "city": "FLORISSANT",
            "state": "MO",
            "postal_code": "630332807",
            "telephone_number": "314-732-2302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE NUTRITION SERVICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-01",
        "last_updated": "2021-02-03",
        "certification_date": "2021-02-03",
        "status": "A",
        "authorized_official_last_name": "HAMILTON",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "GENENE",
        "authorized_official_title_or_position": "OWNER/EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "314-732-2302",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RDLD"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1134657208",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "desktop",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2080 Cordoba Dr",
            "city": "Florissant",
            "state": "MO",
            "country_code": "US",
            "postal_code": "630332807",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Divinee Truth LLC
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• Robert Austin Djali, D.P.M
• DLB Health, LLC

• Registered Dietitian in Florissant, MO
• Providers in Florissant, MO by specialty
• Registered Dietitian in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 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.