Active NPI
Samantha Kepler Van Dyke, MPH, RD
- Registered Dietitian
- Charlottesville, VA
National Provider Identifier
1275024259
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86020035
- Practice address
- 152 Burnet St
Charlottesville, VA 22902-5501 - Phone
- (703) 851-6414
- NPI assigned
- May 24, 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 | 86020035 | VA | Primary |
Addresses
Primary practice location
152 Burnet St
Charlottesville, VA 22902-5501
Mailing address
152 Burnet St
Charlottesville, VA 22902-5501
Phone (703) 851-6414
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 |
|---|---|---|---|
| 86020035 | VA | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1527120000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1527120000000",
"number": "1275024259",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "152 BURNET ST",
"city": "CHARLOTTESVILLE",
"state": "VA",
"postal_code": "229025501",
"telephone_number": "703-851-6414"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "152 BURNET ST",
"city": "CHARLOTTESVILLE",
"state": "VA",
"postal_code": "229025501",
"telephone_number": "703-851-6414"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN DYKE",
"first_name": "SAMANTHA",
"middle_name": "KEPLER",
"credential": "MPH, RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-05-24",
"last_updated": "2018-05-24",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "VA",
"license": "86020035",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlottesville, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 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.