Mandy Lynn Puckett, R.D., M.A., C.D.

Primary specialty

Registered DietitianTaxonomy code 133V00000X

Practice address

2401 W University Ave
Muncie, IN 47303-3428

Phone

(765) 747-3345

Fax

(765) 747-3269

NPI assigned

Nov 13, 2006

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)

Enrolled

Credentials

Master of Arts

Practice roles

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.

• Open Door Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Muncie, IN
  • NPI 1376349316
  NPD (past)

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1376614099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9577 W 400 N",
            "city": "FARMLAND",
            "state": "IN",
            "postal_code": "473409392",
            "telephone_number": "765-468-6321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 W UNIVERSITY AVE",
            "city": "MUNCIE",
            "state": "IN",
            "postal_code": "473033428",
            "telephone_number": "765-747-3345",
            "fax_number": "765-747-3269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUCKETT",
        "first_name": "MANDY",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "R.D., M.A., C.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-13",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly Price
• Primary Telecare LLC
• Taylor Privett, RBT
• Psychological Assessment and Consulting, PC
• Psychology and Beyond
• Brandy Latrice Pugh
• Pulaski Memorial Hospital
• Pulaski Memorial Hospital
• Isabelle Pullon
• Amee Ashish Punater I

• Registered Dietitian in Muncie, IN
• Providers in Muncie, IN by specialty
• Registered Dietitian in Indiana

• 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.

Verify at the official NPI Registry.