Active NPI
Bennington Patrick Wentworth
- Pediatric Nutrition Registered Dietitian
- Memphis, TN
National Provider Identifier
1265060628
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nutrition Registered Dietitian
- License
- 3795
- Practice address
- 848 Adams Ave
Memphis, TN 38103-2816 - Phone
- (901) 287-5437
- NPI assigned
- Mar 31, 2020
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Pediatric Nutrition Registered Dietitian | 133VN1004X | 3795 | TN | Primary |
Addresses
Primary practice location
848 Adams Ave
Memphis, TN 38103-2816
Mailing address
848 Adams Ave
Memphis, TN 38103-2816
Phone (901) 287-5437
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 |
|---|---|---|---|
| 3795 | TN | MD | Pediatric Nutrition Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1585612800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1585612800000",
"number": "1265060628",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "848 ADAMS AVE",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381032816",
"telephone_number": "901-287-5437"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "848 ADAMS AVE",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381032816",
"telephone_number": "901-287-5437"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WENTWORTH",
"first_name": "BENNINGTON",
"middle_name": "PATRICK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-03-31",
"last_updated": "2020-03-31",
"certification_date": "2020-03-31",
"status": "A"
},
"taxonomies": [
{
"code": "133VN1004X",
"taxonomy_group": "",
"desc": "Dietitian, Registered, Nutrition, Pediatric",
"state": "TN",
"license": "3795",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Memphis, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 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.