Kelli Dominick, M.ED., LD, RD, CDE

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

DT05308 Issued in TX

Practice address

712 S Cypress St
Vivian, LA 71082-3206

Phone

(318) 375-2356

NPI assigned

Aug 10, 2010

Last updated

Aug 10, 2010By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 12

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Education

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1281398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1281398400000",
    "number": "1346555703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "712 S CYPRESS ST",
            "city": "VIVIAN",
            "state": "LA",
            "postal_code": "710823206",
            "telephone_number": "318-375-2356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "712 S CYPRESS ST",
            "city": "VIVIAN",
            "state": "LA",
            "postal_code": "710823206",
            "telephone_number": "318-375-2356"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMINICK",
        "first_name": "KELLI",
        "name_prefix": "Mrs.",
        "credential": "M.ED., LD, RD, CDE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-08-10",
        "last_updated": "2010-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133N00000X",
            "taxonomy_group": "",
            "desc": "Nutritionist",
            "state": "TX",
            "license": "DT05308",
            "primary": false
        },
        {
            "code": "133N00000X",
            "taxonomy_group": "",
            "desc": "Nutritionist",
            "state": "LA",
            "license": "1270",
            "primary": false
        },
        {
            "code": "133NN1002X",
            "taxonomy_group": "",
            "desc": "Nutritionist, Nutrition, Education",
            "state": "TX",
            "license": "DT05308",
            "primary": false
        },
        {
            "code": "133NN1002X",
            "taxonomy_group": "",
            "desc": "Nutritionist, Nutrition, Education",
            "state": "LA",
            "license": "1270",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "TX",
            "license": "DT05308",
            "primary": true
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "LA",
            "license": "1270",
            "primary": false
        },
        {
            "code": "133VN1004X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Pediatric",
            "state": "TX",
            "license": "DT05308",
            "primary": false
        },
        {
            "code": "133VN1004X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Pediatric",
            "state": "LA",
            "license": "1270",
            "primary": false
        },
        {
            "code": "133VN1005X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Renal",
            "state": "TX",
            "license": "DT05308",
            "primary": false
        },
        {
            "code": "133VN1005X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Renal",
            "state": "LA",
            "license": "1270",
            "primary": false
        },
        {
            "code": "133VN1006X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Metabolic",
            "state": "TX",
            "license": "DT05308",
            "primary": false
        },
        {
            "code": "133VN1006X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Metabolic",
            "state": "LA",
            "license": "1270",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Registered Dietitian in Vivian, LA
• Providers in Vivian, LA by specialty
• Registered Dietitian in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.