Active NPI
Kaitlin Wiley, RD
- Registered Dietitian
- South Bend, IN
National Provider Identifier
1245729946
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86084314
- Practice address
- 615 N Michigan St
South Bend, IN 46601-1033 - Phone
- (574) 647-6353
- NPI assigned
- May 8, 2018
- 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 | 86084314 | Primary |
Addresses
Primary practice location
615 N Michigan St
South Bend, IN 46601-1033
Mailing address
5642 Osage Lake Dr Apt 1B
Mishawaka, IN 46545-8451
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1525737600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1525737600000",
"number": "1245729946",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5642 OSAGE LAKE DR APT 1B",
"city": "MISHAWAKA",
"state": "IN",
"postal_code": "465458451"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "615 N MICHIGAN ST",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466011033",
"telephone_number": "574-647-6353"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILEY",
"first_name": "KAITLIN",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-05-08",
"last_updated": "2018-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": null,
"license": "86084314",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Bend, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.