Active NPI
Breanna Nicole Richardson, R.D.
- Registered Dietitian
- Grants Pass, OR
National Provider Identifier
1407306871
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- LD-D-10159157
- Practice address
- 500 SW Ramsey Ave
Grants Pass, OR 97527-5554 - Phone
- (541) 472-7120
- Fax
- (541) 472-7123
- NPI assigned
- Oct 10, 2016
- 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 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | LD-D-10159157 | OR | Primary |
| Pediatric Nutrition Registered Dietitian | 133VN1004X | LD-D-10159157 | OR | |
| Renal Nutrition Registered Dietitian | 133VN1005X | LD-D-10159157 | OR | |
| Metabolic Nutrition Registered Dietitian | 133VN1006X | LD-D-10159157 | OR |
Addresses
Primary practice location
500 SW Ramsey Ave
Grants Pass, OR 97527-5554
Mailing address
2620 E Barnett Rd
#H
Medford, OR 97504-8344
Phone (541) 789-4281
Other names 1
- Breanna Nicole Whittaker
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LD-D-10159157 | OR | MD | Metabolic Nutrition Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1476057600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1476057600000",
"number": "1407306871",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2620 E BARNETT RD",
"address_2": "#H",
"city": "MEDFORD",
"state": "OR",
"postal_code": "975048344",
"telephone_number": "541-789-4281",
"fax_number": "541-789-2558"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 SW RAMSEY AVE",
"city": "GRANTS PASS",
"state": "OR",
"postal_code": "975275554",
"telephone_number": "541-472-7120",
"fax_number": "541-472-7123"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RICHARDSON",
"first_name": "BREANNA",
"middle_name": "NICOLE",
"name_prefix": "Mrs.",
"credential": "R.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-10-10",
"last_updated": "2016-10-10",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "OR",
"license": "LD-D-10159157",
"primary": true
},
{
"code": "133VN1004X",
"taxonomy_group": "",
"desc": "Dietitian, Registered, Nutrition, Pediatric",
"state": "OR",
"license": "LD-D-10159157",
"primary": false
},
{
"code": "133VN1005X",
"taxonomy_group": "",
"desc": "Dietitian, Registered, Nutrition, Renal",
"state": "OR",
"license": "LD-D-10159157",
"primary": false
},
{
"code": "133VN1006X",
"taxonomy_group": "",
"desc": "Dietitian, Registered, Nutrition, Metabolic",
"state": "OR",
"license": "LD-D-10159157",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "BREANNA",
"last_name": "WHITTAKER",
"middle_name": "NICOLE",
"credential": "R.D.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Grants Pass, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.