Active NPI
Michael Joshua Wootson I, RD, LDN
- Registered Dietitian
- Willingboro, NJ
National Provider Identifier
1336872746
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- DN007628
- Practice address
- 43 Middleton LN
Willingboro, NJ 08046-3127 - Phone
- (609) 379-0196
- NPI assigned
- Jul 4, 2022
- 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 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nutrition Registered Dietitian | 133VN1004X | |||
| Gerontological Nutrition Registered Dietitian | 133VN1101X | |||
| Sports Dietetics Nutrition Registered Dietitian | 133VN1501X | |||
| Registered Dietitian | 133V00000X | DN007628 | PA | Primary |
Addresses
Primary practice location
43 Middleton LN
Willingboro, NJ 08046-3127
Mailing address
43 Middleton LN
Willingboro, NJ 08046-3127
Phone (609) 379-0196
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 |
|---|---|---|---|
| DN007628 | PA | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wootson Health & Wellness | Dietitian, Registered | Current | Accepting new patients |
| Nourish, Inc. | Dietitian, Registered | Past | Accepting new patients |
| Fay Nutrition | Dietitian, Registered | Past | Accepting new patients |
| Marjorie Nolan Cohn LLC | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 4
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1656892800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1656892800000",
"number": "1336872746",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "43 MIDDLETON LN",
"city": "WILLINGBORO",
"state": "NJ",
"postal_code": "080463127",
"telephone_number": "609-379-0196"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "43 MIDDLETON LN",
"city": "WILLINGBORO",
"state": "NJ",
"postal_code": "080463127",
"telephone_number": "609-379-0196"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOOTSON",
"first_name": "MICHAEL",
"middle_name": "JOSHUA",
"name_suffix": "I",
"credential": "RD, LDN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-07-04",
"last_updated": "2022-07-04",
"certification_date": "2022-07-04",
"status": "A"
},
"taxonomies": [
{
"code": "133VN1004X",
"taxonomy_group": "",
"desc": "Dietitian, Registered, Nutrition, Pediatric",
"state": null,
"license": null,
"primary": false
},
{
"code": "133VN1101X",
"taxonomy_group": "",
"desc": "Dietitian, Registered, Nutrition, Gerontological",
"state": null,
"license": null,
"primary": false
},
{
"code": "133VN1501X",
"taxonomy_group": "",
"desc": "Dietitian, Registered, Nutrition, Sports Dietetics",
"state": null,
"license": null,
"primary": false
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "PA",
"license": "DN007628",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Willingboro, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.