Active NPI
Melissa Ellis
- Registered Dietitian
- Prescott, AZ
National Provider Identifier
1255702189
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- Practice address
- 1003 Willow Creek Rd
Prescott, AZ 86314 - Phone
- (928) 759-5821
- Fax
- (928) 759-5827
- NPI assigned
- Oct 19, 2015
- 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 | Primary |
Addresses
Primary practice location
1003 Willow Creek Rd
Prescott, AZ 86314
Mailing address
1003 Willow Creek Rd.
Prescott, AZ 86314
Phone (928) 759-5821
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": "1445212800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1445212800000",
"number": "1255702189",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1003 WILLOW CREEK RD.",
"city": "PRESCOTT",
"state": "AZ",
"postal_code": "86314",
"telephone_number": "928-759-5821",
"fax_number": "928-759-5827"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1003 WILLOW CREEK RD",
"city": "PRESCOTT",
"state": "AZ",
"postal_code": "86314",
"telephone_number": "928-759-5821",
"fax_number": "928-759-5827"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "MELISSA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-10-19",
"last_updated": "2015-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Prescott, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.