Active NPI
Mary Jo Johnson, RD, CDE
- Metabolic Nutrition Registered Dietitian
- Martinsburg, WV
National Provider Identifier
1396836003
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Metabolic Nutrition Registered Dietitian
- License
- 716432
- Practice address
- 510 Butler Ave
Veterans Affairs Medical Center
Martinsburg, WV 25405 - Phone
- (304) 263-0811
- Fax
- (304) 262-7435
- NPI assigned
- Sep 27, 2006
- 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 |
|---|---|---|---|---|
| Metabolic Nutrition Registered Dietitian | 133VN1006X | 716432 | VA | Primary |
Addresses
Primary practice location
510 Butler Ave
Veterans Affairs Medical Center
Martinsburg, WV 25405
Mailing address
100 W. North Ave
Winchester, VA 22601
Phone (540) 662-0754
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 |
|---|---|---|---|
| 716432 | VA | MD | Metabolic Nutrition Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159315200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1396836003",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 W. NORTH AVE",
"city": "WINCHESTER",
"state": "VA",
"postal_code": "22601",
"telephone_number": "540-662-0754"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "510 BUTLER AVE",
"address_2": "VETERANS AFFAIRS MEDICAL CENTER",
"city": "MARTINSBURG",
"state": "WV",
"postal_code": "25405",
"telephone_number": "304-263-0811",
"fax_number": "304-262-7435"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "MARY",
"middle_name": "JO",
"name_prefix": "Mrs.",
"credential": "RD, CDE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "133VN1006X",
"taxonomy_group": "",
"desc": "Dietitian, Registered, Nutrition, Metabolic",
"state": "VA",
"license": "716432",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Martinsburg, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.