Active NPI
Thomas Mellette, MS, RD, LDN, CNSC
- Registered Dietitian
- Raleigh, NC
National Provider Identifier
1326674789
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- L005168
- Practice address
- 11220 N Radner Way
Raleigh, NC 27613-5530 - Phone
- (919) 213-0161
- NPI assigned
- Mar 18, 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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | L005168 | NC | Primary |
Addresses
Primary practice location
11220 N Radner Way
Raleigh, NC 27613-5530
Mailing address
11220 N Radner Way
Raleigh, NC 27613-5530
Phone (919) 213-0161
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L005168 | NC | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1584489600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1638835200000",
"number": "1326674789",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11220 N RADNER WAY",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276135530",
"telephone_number": "919-213-0161"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11220 N RADNER WAY",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276135530",
"telephone_number": "919-213-0161"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MELLETTE",
"first_name": "THOMAS",
"credential": "MS, RD, LDN, CNSC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-03-18",
"last_updated": "2021-12-07",
"certification_date": "2021-12-07",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NC",
"license": "L005168",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Raleigh, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.