Excellis Nutrition LLC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

Legal business name

EXCELLIS NUTRITION LLC

Practice address

475 E FM 1382 Unit 2572
Cedar Hill, TX 75106-5118

Phone

(469) 708-6940

NPI assigned

Jan 16, 2024

Organization subpart

No

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

Authorized official

Name

Dr. Stacie Vanessa Ellis, PHD, RDN, LDNPI 1275917882

Title

Owner and Registered Dietitian

Phone

(469) 708-6940

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Stacie Vanessa Ellis, RDN, LD

  • Registered Dietitian
  • Cedar Hill, TX
  • NPI 1275917882

  Dietitian, Registered

  NPD Authorized official

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

{
    "created_epoch": "1705363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705363200000",
    "number": "1417718602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2572",
            "city": "CEDAR HILL",
            "state": "TX",
            "postal_code": "751062572",
            "telephone_number": "469-708-6940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 E FM 1382 UNIT 2572",
            "city": "CEDAR HILL",
            "state": "TX",
            "postal_code": "751065118",
            "telephone_number": "469-708-6940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCELLIS NUTRITION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-16",
        "last_updated": "2024-01-16",
        "certification_date": "2024-01-16",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "STACIE",
        "authorized_official_middle_name": "VANESSA",
        "authorized_official_title_or_position": "OWNER AND REGISTERED DIETITIAN",
        "authorized_official_telephone_number": "469-708-6940",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD, RDN, LD"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 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.