Active NPI
Janet Larsen Deloughery, R.D.L.N.
- Registered Dietitian
- Wagner, SD
National Provider Identifier
1295755197
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 0263
- Practice address
- 111 Washington Ave NW
Wagner, SD 57380 - Phone
- (605) 384-3621
- Fax
- (605) 384-3293
- NPI assigned
- Jul 20, 2006
- Last updated
- Jul 9, 2007
- 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 | 0263 | SD | Primary |
Addresses
Primary practice location
111 Washington Ave NW
Wagner, SD 57380
Mailing address
111 Washington Ave NW
Wagner, SD 57380
Phone (605) 384-3621
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5540030 | Medicaid | SD | |
| 5540100 | Medicaid | SD |
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 |
|---|---|---|---|
| 0263 | SD | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1295755197",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 WASHINGTON AVE NW",
"city": "WAGNER",
"state": "SD",
"postal_code": "57380",
"telephone_number": "605-384-3621",
"fax_number": "605-384-3293"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 WASHINGTON AVE NW",
"city": "WAGNER",
"state": "SD",
"postal_code": "57380",
"telephone_number": "605-384-3621",
"fax_number": "605-384-3293"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DELOUGHERY",
"first_name": "JANET",
"middle_name": "LARSEN",
"credential": "R.D.L.N.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-20",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "SD",
"license": "0263",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5540030",
"state": "SD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5540100",
"state": "SD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wagner, SD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.