Active NPI
Doherty Nutrition LLC
- Registered Dietitian
- Dallas, TX
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- Legal business name
- DOHERTY NUTRITION LLC
- Practice address
- 17060 Dallas Pkwy Ste 112
Dallas, TX 75248-1905 - Phone
- (469) 372-2022
- Fax
- (833) 290-5413
- NPI assigned
- Jan 29, 2019
- Last updated
- Mar 7, 2024
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Krista Wyatt
- Title
- Operations Manager
- Phone
- (469) 372-2022
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | NU | Primary |
Addresses
Primary practice location
17060 Dallas Pkwy Ste 112
Dallas, TX 75248-1905
Mailing address
17060 Dallas Pkwy Ste 112
Dallas, TX 75248-1905
Phone (469) 372-2022
Other practice location 1
650 Warrenville Rd Ste 100
Lisle, IL 60532-4315
Phone (847) 318-3013
Other practice location 2
901 S Mopac Expy Ste 300
Austin, TX 78746-5883
Phone (737) 212-9290
Other practice location 3
101 Summit Ave Ste 907
Fort Worth, TX 76102-2613
Phone (817) 438-8044
Other practice location 4
771 E Southlake Blvd Ste 106
Southlake, TX 76092-6354
Phone (469) 372-2022
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX, IL
Enrollment records 2
National Provider Directory
National Provider DirectoryLocations
1 Northfield Plz
Ste 300
Northfield, IL 60093
Phone (847) 318-3013
901 S Mopac Expy
Ste 300
Austin, TX 78746
Phone (512) 735-3013
17060 Dallas Pkwy
Ste 112
Dallas, TX 75248
Phone (469) 372-2022
17060 Dallas Pkwy
Ste 213
Dallas, TX 75248
Phone (469) 372-2022
101 Summit Ave
Ste 907
Fort Worth, TX 76102
Phone (817) 438-8044
771 E Southlake Blvd
Ste 106
Southlake, TX 76092
Phone (469) 372-2022
Practitioners & affiliated clinicians
Practitioners 38
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1548720000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1709769600000",
"number": "1326502832",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17060 DALLAS PKWY STE 112",
"city": "DALLAS",
"state": "TX",
"postal_code": "752481905",
"telephone_number": "469-372-2022",
"fax_number": "833-290-5413"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17060 DALLAS PKWY STE 112",
"city": "DALLAS",
"state": "TX",
"postal_code": "752481905",
"telephone_number": "469-372-2022",
"fax_number": "833-290-5413"
}
],
"practiceLocations": [
{
"address_1": "650 Warrenville Rd Ste 100",
"address_purpose": "LOCATION",
"city": "Lisle",
"state": "IL",
"postal_code": "605324315",
"country_code": "US",
"telephone_number": "847-318-3013",
"fax_number": "833-290-5413",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "901 S Mopac Expy Ste 300",
"address_purpose": "LOCATION",
"city": "Austin",
"state": "TX",
"postal_code": "787465883",
"country_code": "US",
"telephone_number": "737-212-9290",
"fax_number": "833-290-5413",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "101 Summit Ave Ste 907",
"address_purpose": "LOCATION",
"city": "Fort Worth",
"state": "TX",
"postal_code": "761022613",
"country_code": "US",
"telephone_number": "817-438-8044",
"fax_number": "833-290-5413",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "771 E Southlake Blvd Ste 106",
"address_purpose": "LOCATION",
"city": "Southlake",
"state": "TX",
"postal_code": "760926354",
"country_code": "US",
"telephone_number": "469-372-2022",
"fax_number": "833-290-5413",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "DOHERTY NUTRITION LLC",
"organizational_subpart": "NO",
"enumeration_date": "2019-01-29",
"last_updated": "2024-03-07",
"certification_date": "2024-03-07",
"status": "A",
"authorized_official_last_name": "WYATT",
"authorized_official_first_name": "KRISTA",
"authorized_official_title_or_position": "OPERATIONS MANAGER",
"authorized_official_telephone_number": "469-372-2022"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.