Connie Jean Wildt, RD,LD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

2001024181 Issued in MO

Practice address

615 S. New Ballas Rd
St. Louis, MO 63141-8221

Phone

(314) 251-4998

Fax

(314) 251-7247

NPI assigned

Apr 2, 2009

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1238630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1238630400000",
    "number": "1356583504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 S. NEW BALLAS ROAD",
            "address_2": "ST. JOHN'S MERCY MEDICAL CENTER- JFK CLINIC",
            "city": "ST. LOUIS",
            "state": "MO",
            "postal_code": "631418277",
            "telephone_number": "314-251-4998",
            "fax_number": "314-251-7247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 S. NEW BALLAS RD",
            "city": "ST. LOUIS",
            "state": "MO",
            "postal_code": "631418221",
            "telephone_number": "314-251-4998",
            "fax_number": "314-251-7247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDT",
        "first_name": "CONNIE",
        "middle_name": "JEAN",
        "name_prefix": "Ms.",
        "credential": "RD,LD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-04-02",
        "last_updated": "2009-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "MO",
            "license": "2001024181",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Wilder, MS, LPC
• Cathy Wilderman, BS, CSS
• Taylor Wildermuth, OTR/L
• Troy Shepard Wildes, MD
• Aaron Joshua Wildman
• Kristy Lynne Wildt, PA-C
• Wildwood Chiropractic, Inc
• Karley Darlene Wileman, RBT
• Lauren Nicole Wiley, PA
• Lauren Elizabeth Sachs Wilfling, D.O., MBA

• Registered Dietitian in St. Louis, MO
• Providers in St. Louis, MO by specialty
• Registered Dietitian in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2009; 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.