Active NPI
Jennifer Lyman, RDN, LD
- Registered Dietitian
- O'Fallon, MO
National Provider Identifier
1215320031
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 2014030811
- Practice address
- 18 W Industrial Dr
O Fallon, MO 63366-1926 - Phone
- (314) 626-3472
- NPI assigned
- Mar 18, 2015
- Last updated
- Sep 26, 2020
- Sex
- Female
- Sole proprietor
- No
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 | 2014030811 | MO | Primary |
Addresses
Primary practice location
18 W Industrial Dr
O Fallon, MO 63366-1926
Mailing address
72 Freymuth Rd
Lake Saint Louis, MO 63367-1906
Phone (314) 322-8407
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| New Leaf Nutrition | Dietitian, Registered | Current | Accepting new patients |
Locations
18 W Industrial Dr
O Fallon, MO 63366
Phone (314) 626-3472
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1426636800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1601078400000",
"number": "1215320031",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "72 FREYMUTH RD",
"city": "LAKE SAINT LOUIS",
"state": "MO",
"postal_code": "633671906",
"telephone_number": "314-322-8407",
"fax_number": "314-344-6592"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18 W INDUSTRIAL DR",
"city": "O FALLON",
"state": "MO",
"postal_code": "633661926",
"telephone_number": "314-626-3472"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LYMAN",
"first_name": "JENNIFER",
"credential": "RDN, LD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-03-18",
"last_updated": "2020-09-26",
"certification_date": "2020-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MO",
"license": "2014030811",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in O'Fallon, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.