Phyllis Bergie-Moore, RD

Primary specialty

Metabolic Nutrition Registered DietitianTaxonomy code 133VN1006X

Practice address

144 Stony Point Rd
Santa Rosa, CA 95401-4122

Phone

(707) 521-4649

Fax

(707) 521-4628

NPI assigned

Jan 20, 2009

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

• Phyllis Vaughn Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1232409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1272499200000",
    "number": "1164669792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "144 STONY POINT RD",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954014122",
            "telephone_number": "707-521-4649",
            "fax_number": "707-521-4628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "144 STONY POINT RD",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954014122",
            "telephone_number": "707-521-4649",
            "fax_number": "707-521-4628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGIE-MOORE",
        "first_name": "PHYLLIS",
        "credential": "RD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-01-20",
        "last_updated": "2010-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133VN1006X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Metabolic",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PHYLLIS",
            "last_name": "VAUGHN",
            "credential": "LRD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jelena Berena, MD
• Roberta L Berg, MD
• Stephen Scott Berger, DDS
• Sharon Bergeron, LMFT
• Jennifer Berghof, LMFT
• Kevin Bergman, M.D.
• Lynn Lokelani Bergman, M.A., M.F.T.
• Habteab Yohannes Berhane
• Jessica Berkana, LMFT
• Laura A. Berke, RN, FNP

• Metabolic Nutrition Registered Dietitian in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Metabolic Nutrition Registered Dietitian in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2010; 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.