Active NPI
Josephine Buckley, RD
- Registered Dietitian
- Fenton, MO
National Provider Identifier
1235909599
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 2021035601
- Practice address
- 320 Gravois Rd # 210-230
Fenton, MO 63026-4122 - Phone
- (636) 600-0446
- NPI assigned
- Jan 8, 2024
- Last updated
- Jan 8, 2024
- 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 | 2021035601 | MO | Primary |
Addresses
Primary practice location
320 Gravois Rd # 210-230
Fenton, MO 63026-4122
Mailing address
8808 Sheryl Ann Dr
Saint Louis, MO 63126-2132
Phone (314) 580-6036
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2021035601 | MO | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Osage Valley Counseling LLC | Dietitian, Registered | Past | Accepting new patients |
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": "1704672000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1704672000000",
"number": "1235909599",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8808 SHERYL ANN DR",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631262132",
"telephone_number": "314-580-6036"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "320 GRAVOIS RD # 210-230",
"city": "FENTON",
"state": "MO",
"postal_code": "630264122",
"telephone_number": "636-600-0446"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUCKLEY",
"first_name": "JOSEPHINE",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-01-08",
"last_updated": "2024-01-08",
"certification_date": "2024-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MO",
"license": "2021035601",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fenton, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 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.