Active NPI
Karen Elizabeth Revak, RDN
- Registered Dietitian
- Hooksett, NH
National Provider Identifier
1417778945
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 0501
- Practice address
- 1465 Hooksett Rd Unit 323
Hooksett, NH 03106-1812 - Phone
- (603) 860-8389
- NPI assigned
- Oct 17, 2024
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 0501 | NH | Primary |
Addresses
Primary practice location
1465 Hooksett Rd Unit 323
Hooksett, NH 03106-1812
Mailing address
1465 Hooksett Rd Unit 323
Hooksett, NH 03106-1812
Phone (603) 860-8389
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 |
|---|---|---|---|
| 0501 | NH | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nourish, Inc. | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 1
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": "1729123200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1729123200000",
"number": "1417778945",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1465 HOOKSETT RD UNIT 323",
"city": "HOOKSETT",
"state": "NH",
"postal_code": "031061812",
"telephone_number": "603-860-8389"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1465 HOOKSETT RD UNIT 323",
"city": "HOOKSETT",
"state": "NH",
"postal_code": "031061812",
"telephone_number": "603-860-8389"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REVAK",
"first_name": "KAREN",
"middle_name": "ELIZABETH",
"credential": "RDN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-10-17",
"last_updated": "2024-10-17",
"certification_date": "2024-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dietitian, Registered",
"state": "NH",
"license": "0501",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hooksett, NH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 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.