NPIMap

Individual provider Active NPI

Kyskie Bolton, RD

  • Registered Dietitian
  • Madison, MS
National Provider Identifier
1396987376
Registry record updated Sep 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
D1245 Issued in MS
Practice address
272 Calhoun Station Parkway Ste C
#1199
Madison, MS 39110
Phone
(601) 573-6667
NPI assigned
Apr 6, 2009
Last updated
Sep 26, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X D1245 MS Primary

Addresses

Primary practice location

272 Calhoun Station Parkway Ste C
#1199
Madison, MS 39110

Mailing address

272 Calhoun Station Parkway
Suite C #1199
Madison, MS 39110
Phone (601) 573-6667

Other identifiers 1

IdentifierTypeStateIssuer
06381069MedicaidMS

Electronic endpoints 2

TypeEndpointUseAffiliation
CONNECT URL CANTON Health Information Exchange (HIE) G A Carmichael Family Health Center Inc
Direct Messaging Address kyskieb-rd@outlook.com

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)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Nutrition Services, LLC Dietitian, Registered Current Accepting new patients
Fay Nutrition Dietitian, Registered Past Accepting new patients
Mochi Medical Ca PC Past Accepting new patients
G a Carmichael Family Health Center Inc Past Accepting new patients
Nourish, Inc. Dietitian, Registered Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: kyskie.bolton.p1@direct.gacfhc.nextgenshare.com
  • Direct secure messaging: otherservices.nutrionist.p1@direct.gacfhc.nextgenshare.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1238976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727308800000",
    "number": "1396987376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "272 CALHOUN STATION PARKWAY",
            "address_2": "SUITE C #1199",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "39110",
            "telephone_number": "601-573-6667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "272 CALHOUN STATION PARKWAY STE C",
            "address_2": "#1199",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "39110",
            "telephone_number": "601-573-6667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLTON",
        "first_name": "KYSKIE",
        "credential": "RD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-06",
        "last_updated": "2024-09-26",
        "certification_date": "2024-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "MS",
            "license": "D1245",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06381069",
            "state": "MS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "CANTON",
            "affiliation": "Y",
            "affiliationName": "G A Carmichael Family Health Center Inc",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1668 West Peace Street",
            "city": "Canton",
            "state": "MS",
            "country_code": "US",
            "postal_code": "39046",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kyskieb-rd@outlook.com",
            "affiliation": "N",
            "address_1": "272 Calhoun Station Parkway Ste C",
            "address_2": "#1199",
            "city": "Madison",
            "state": "MS",
            "country_code": "US",
            "postal_code": "39110",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Madison, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2024; 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.