Active NPI
Stacie Vanessa Ellis, RDN, LD
- Registered Dietitian
- Cedar Hill, TX
National Provider Identifier
1275917882
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- DT83743
- Practice address
- 1200 Sullivan Dr
Cedar Hill, TX 75104-7340 - Phone
- (254) 449-3952
- NPI assigned
- Jul 13, 2015
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nutritionist | 133N00000X | DT83743 | TX | |
| Registered Dietitian | 133V00000X | DT83743 | TX | Primary |
Addresses
Primary practice location
1200 Sullivan Dr
Cedar Hill, TX 75104-7340
Mailing address
1200 Sullivan Dr
Cedar Hill, TX 75104-7340
Phone (254) 449-3952
Other names 1
- Dr. Stacie Vanessa Jones
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DT83743 | TX | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Excellis Nutrition LLC | Dietitian, Registered | Current | Accepting new patients |
| Mobile Medical Consultants, PLLC | Past | Accepting new patients | |
| Fay Nutrition | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Physician
- Dallas, TX
- NPI 1346839859
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1436745600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701302400000",
"number": "1275917882",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1200 SULLIVAN DR",
"city": "CEDAR HILL",
"state": "TX",
"postal_code": "751047340",
"telephone_number": "254-449-3952"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 SULLIVAN DR",
"city": "CEDAR HILL",
"state": "TX",
"postal_code": "751047340",
"telephone_number": "254-449-3952"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "STACIE",
"middle_name": "VANESSA",
"name_prefix": "Dr.",
"credential": "RDN, LD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-07-13",
"last_updated": "2023-11-30",
"certification_date": "2023-11-30",
"status": "A"
},
"taxonomies": [
{
"code": "133N00000X",
"taxonomy_group": "",
"desc": "Nutritionist",
"state": "TX",
"license": "DT83743",
"primary": false
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "TX",
"license": "DT83743",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "STACIE",
"last_name": "JONES",
"middle_name": "VANESSA",
"prefix": "DR.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Cedar Hill, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.