Active NPI
Lydia C Wickenhoefer, RD LD
- Registered Dietitian
- Beaufort, SC
National Provider Identifier
1366917940
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 1406
- Practice address
- 955 Ribaut Rd
Beaufort, SC 29902-5441 - Phone
- (843) 522-5085
- NPI assigned
- Oct 10, 2018
- Last updated
- Oct 10, 2018
- 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 | 1406 | SC | Primary |
Addresses
Primary practice location
955 Ribaut Rd
Beaufort, SC 29902-5441
Mailing address
955 Ribaut Rd
Beaufort, SC 29902-5441
Phone (843) 522-5085
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PENDING | Medicaid | SC |
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 |
|---|---|---|---|
| 1406 | SC | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1539129600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1539129600000",
"number": "1366917940",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "955 RIBAUT RD",
"city": "BEAUFORT",
"state": "SC",
"postal_code": "299025441",
"telephone_number": "843-522-5085"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "955 RIBAUT RD",
"city": "BEAUFORT",
"state": "SC",
"postal_code": "299025441",
"telephone_number": "843-522-5085"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WICKENHOEFER",
"first_name": "LYDIA",
"middle_name": "C",
"credential": "RD LD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-10-10",
"last_updated": "2018-10-10",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "SC",
"license": "1406",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PENDING",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Beaufort, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.