Active NPI
Nicole Marie McKibben, RDN
- Registered Dietitian
- Decatur, GA
National Provider Identifier
1174348692
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 005969
- Practice address
- 2641 E College Ave Apt 474
Decatur, GA 30030-3760 - Phone
- (260) 463-1927
- NPI assigned
- Nov 19, 2024
- Sex
- Female
- Sole proprietor
- Yes
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 | 005969 | GA | Primary |
Addresses
Primary practice location
2641 E College Ave Apt 474
Decatur, GA 30030-3760
Mailing address
2641 E College Ave Apt 474
Decatur, GA 30030-3760
Phone (260) 463-1927
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)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Marjorie Nolan Cohn LLC | Dietitian, Registered | Past | Accepting new patients |
| Fay Nutrition | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 2
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1731974400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1731974400000",
"number": "1174348692",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2641 E COLLEGE AVE APT 474",
"city": "DECATUR",
"state": "GA",
"postal_code": "300303760",
"telephone_number": "260-463-1927"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2641 E COLLEGE AVE APT 474",
"city": "DECATUR",
"state": "GA",
"postal_code": "300303760",
"telephone_number": "260-463-1927"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCKIBBEN",
"first_name": "NICOLE",
"middle_name": "MARIE",
"credential": "RDN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-11-19",
"last_updated": "2024-11-19",
"certification_date": "2024-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "GA",
"license": "005969",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Decatur, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 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.