Active NPI
Priscilla Jo Green, RD
- Registered Dietitian
- Los Cerrillos, NM
National Provider Identifier
1386107308
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- LD-0653
- Practice address
- 351 Red Rock Road
Los Cerrillos, NM 87010 - Phone
- (505) 274-8939
- NPI assigned
- Apr 8, 2019
- 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 | LD-0653 | NM | Primary |
Addresses
Primary practice location
351 Red Rock Road
Los Cerrillos, NM 87010
Mailing address
HC 63 Box 30
Pena Blanca, NM 87041-9701
Phone (505) 274-8939
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| LD-0653 | Other | NM | SELF PAY |
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 |
|---|---|---|---|
| LD-0653 | NM | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1554681600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560211200000",
"number": "1386107308",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "HC 63 BOX 30",
"city": "PENA BLANCA",
"state": "NM",
"postal_code": "870419701",
"telephone_number": "505-274-8939"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "351 RED ROCK ROAD",
"city": "LOS CERRILLOS",
"state": "NM",
"postal_code": "87010",
"telephone_number": "505-274-8939"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "PRISCILLA",
"middle_name": "JO",
"name_prefix": "Ms.",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-04-08",
"last_updated": "2019-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NM",
"license": "LD-0653",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SELF PAY",
"identifier": "LD-0653",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.