Wanda L King, M.S., RDN, CLC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

MED-NUTR-LIC-581 Issued in MT

Practice address

6 Thirteenth Avenue East
Poslon, MT 59860

Phone

(406) 883-8454

NPI assigned

Aug 13, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Wanda Wildenberg Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

Practice roles

Interoperability endpoints

• Direct secure messaging: wwildenberg203797@wm.providencedirect.org

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.

• Providence Health & Services Mt

  • Pulmonary Disease Physician
  • Missoula, MT
  • NPI 1427096585
  NPD (past)

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

{
    "created_epoch": "1407888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624233600000",
    "number": "1154730364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1010",
            "city": "POLSON",
            "state": "MT",
            "postal_code": "598601010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 THIRTEENTH AVENUE EAST",
            "city": "POSLON",
            "state": "MT",
            "postal_code": "59860",
            "telephone_number": "406-883-8454"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "900 N Orange St Ste 304",
            "address_purpose": "LOCATION",
            "city": "Missoula",
            "state": "MT",
            "postal_code": "598022951",
            "country_code": "US",
            "telephone_number": "406-329-5781",
            "fax_number": "406-883-8655",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KING",
        "first_name": "WANDA",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "M.S., RDN, CLC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-13",
        "last_updated": "2021-06-21",
        "certification_date": "2021-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "MT",
            "license": "MED-NUTR-LIC-581",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "wwildenberg203797@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "900 N Orange St Ste 304",
            "city": "Missoula",
            "state": "MT",
            "country_code": "US",
            "postal_code": "598022951",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "WANDA",
            "last_name": "WILDENBERG",
            "credential": "M.S., RDN, CLC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 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.