Active NPI
Annika Lenore Dougherty Imelli, RD, IBCLC
- Registered Dietitian
- Polaris, MT
National Provider Identifier
1194411447
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- MED-NUT-LIC-125402
- Practice address
- 141 Aspen View Rd
Polaris, MT 59746 - Phone
- (415) 606-9558
- NPI assigned
- Apr 11, 2023
- Last updated
- Jan 3, 2025
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | MED-NUT-LIC-125402 | MT | Primary |
| Lactation Consultant (Non-RN) | 174N00000X | L-21954 | NU |
Addresses
Primary practice location
141 Aspen View Rd
Polaris, MT 59746
Mailing address
PO Box 460458
Polaris, MT 59746-0458
Phone (415) 606-9558
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MED-NUT-LIC-125402 | MT | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1681171200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1735862400000",
"number": "1194411447",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 460458",
"city": "POLARIS",
"state": "MT",
"postal_code": "597460458",
"telephone_number": "415-606-9558"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "141 ASPEN VIEW RD",
"city": "POLARIS",
"state": "MT",
"postal_code": "59746",
"telephone_number": "415-606-9558"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IMELLI",
"first_name": "ANNIKA",
"middle_name": "LENORE DOUGHERTY",
"credential": "RD, IBCLC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-04-11",
"last_updated": "2025-01-03",
"certification_date": "2025-01-03",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MT",
"license": "MED-NUT-LIC-125402",
"primary": true
},
{
"code": "174N00000X",
"taxonomy_group": "",
"desc": "Lactation Consultant, Non-RN",
"state": "NU",
"license": "L-21954",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Polaris, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.