Individual provider Active NPI

Kerry Lynn Mihalko, RD CDE

  • Registered Dietitian
  • Jamestown, NY
National Provider Identifier
1407847494
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
000696 Issued in NY
Practice address
207 Foote Ave
Jamestown, NY 14701-6413
Phone
(716) 664-8434
Fax
(716) 664-8606
NPI assigned
Oct 31, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 000696 NY Primary

Addresses

Primary practice location

207 Foote Ave
Jamestown, NY 14701-6413

Mailing address

207 Foote Ave
Jamestown, NY 14701-6413
Phone (716) 664-8434

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121001000180 NY Practitioner - Registered Dietitian Or Nutrition Professional 0042469405 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Blue Circle Dietetics & Nutrition PC Dietitian, Registered CurrentSince Aug 20, 2012 Accepting new patients

Locations

574 Main St
Ste 203
East Aurora, NY 14052
Phone (716) 608-3110

75 S Broadway
Ste 4TH-FL
White Plains, NY 10601
Phone (215) 283-2833

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1130716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1407847494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 FOOTE AVE",
            "city": "JAMESTOWN",
            "state": "NY",
            "postal_code": "147016413",
            "telephone_number": "716-664-8434",
            "fax_number": "716-664-8606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 FOOTE AVE",
            "city": "JAMESTOWN",
            "state": "NY",
            "postal_code": "147016413",
            "telephone_number": "716-664-8434",
            "fax_number": "716-664-8606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIHALKO",
        "first_name": "KERRY",
        "middle_name": "LYNN",
        "credential": "RD CDE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NY",
            "license": "000696",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jamestown, NY

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.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.