Active NPI
Antonia Drysdale, NUTR.
- Registered Dietitian
- Bryan, TX
National Provider Identifier
1336266048
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- DT00515
- Practice address
- 302 E 24TH St
Bryan, TX 77803-5303 - Phone
- (979) 822-6467
- Fax
- (979) 821-9448
- NPI assigned
- Mar 26, 2007
- 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 | DT00515 | TX | Primary |
Addresses
Primary practice location
302 E 24TH St
Bryan, TX 77803-5303
Mailing address
PO Box 4588
Bryan, TX 77805-4588
Phone (979) 822-6467
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DT00515 | Other | TX | DIETITIANS STATE LINCENSE |
| 126130708 | Medicaid | TX |
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 |
|---|---|---|---|
| DT00515 | TX | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Burke Center | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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- Lufkin, TX
- NPI 1396792420
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174867200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1336266048",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 4588",
"city": "BRYAN",
"state": "TX",
"postal_code": "778054588",
"telephone_number": "979-822-6467",
"fax_number": "979-821-9448"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "302 E 24TH ST",
"city": "BRYAN",
"state": "TX",
"postal_code": "778035303",
"telephone_number": "979-822-6467",
"fax_number": "979-821-9448"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DRYSDALE",
"first_name": "ANTONIA",
"credential": "NUTR.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-26",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "TX",
"license": "DT00515",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DIETITIANS STATE LINCENSE",
"identifier": "DT00515",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "126130708",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bryan, TX
- Doss Physical Rehabilitation Associates LLC
- David Doss
- William Lafayette Doss, M.D.
- Dr. Latino Family Clinic PLLC
- Alexya Jayde Drummond, LMSW
- Francine Baldwin Duane, LCSW
- Dubuis Health System, Inc. (Dubuis Hospital of Bryan)
- Abdulaziz Faisal Dudeen, DDS
- Janice Dudley, SPEECH THER.
- Dudycha Pain Clinic PLLC (BCS Pain Clinic)
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.