Active NPI
Kristin L Ellis-Wood, RD, CDN
- Registered Dietitian
- Malone, NY
National Provider Identifier
1447466891
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 005293
- Practice address
- 133 Park St
Alice Hyde Medical Center
Malone, NY 12953-1220 - Phone
- (518) 483-3000
- NPI assigned
- May 15, 2007
- Last updated
- Jul 8, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 005293 | NY | Primary |
Addresses
Primary practice location
133 Park St
Alice Hyde Medical Center
Malone, NY 12953-1220
Mailing address
PO Box 35
Whippleville, NY 12995-0035
Phone (518) 483-3000
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 |
|---|---|---|---|
| 5293 | NY | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179187200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1447466891",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 35",
"city": "WHIPPLEVILLE",
"state": "NY",
"postal_code": "129950035",
"telephone_number": "518-483-3000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "133 PARK ST",
"address_2": "ALICE HYDE MEDICAL CENTER",
"city": "MALONE",
"state": "NY",
"postal_code": "129531220",
"telephone_number": "518-483-3000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS-WOOD",
"first_name": "KRISTIN",
"middle_name": "L",
"name_prefix": "Ms.",
"credential": "RD, CDN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NY",
"license": "005293",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Malone, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.