Active NPI
Nicky Mishko, RDN
- Registered Dietitian
- Tacoma, WA
National Provider Identifier
1225695943
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- DI60927175
- Practice address
- 3315 S 23Rd St Ste 210
Tacoma, WA 98405-1616 - Phone
- (253) 572-8684
- NPI assigned
- May 29, 2019
- 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 | DI60927175 | WA | Primary |
Addresses
Primary practice location
3315 S 23Rd St Ste 210
Tacoma, WA 98405-1616
Mailing address
790 Remington Blvd
Bolingbrook, IL 60440-4909
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 |
|---|---|---|---|
| DI60927175 | WA | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1559088000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1559088000000",
"number": "1225695943",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "790 REMINGTON BLVD",
"city": "BOLINGBROOK",
"state": "IL",
"postal_code": "604404909"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3315 S 23RD ST STE 210",
"city": "TACOMA",
"state": "WA",
"postal_code": "984051616",
"telephone_number": "253-572-8684"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MISHKO",
"first_name": "NICKY",
"credential": "RDN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-05-29",
"last_updated": "2019-05-29",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "WA",
"license": "DI60927175",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tacoma, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.