Glen P Revere, R.D., C.D.E.

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

473669

Practice address

12033 Agency Rd
Parker, AZ 85344-7718

Phone

(928) 669-2137

Fax

(928) 669-3131

NPI assigned

Nov 21, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• US Health Dept of Health & Human Services

  • Federal Public Health Clinic/Center
  • Fort Washakie, WY
  • NPI 1023174299
  NPD (past)
• US Health Dept of Health & Human Services

  • Federal Public Health Clinic/Center
  • Arapahoe, WY
  • NPI 1104976372
  NPD (past)

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

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1477628980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12033 AGENCY RD",
            "city": "PARKER",
            "state": "AZ",
            "postal_code": "853447718",
            "telephone_number": "928-669-2137",
            "fax_number": "928-669-3131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12033 AGENCY RD",
            "city": "PARKER",
            "state": "AZ",
            "postal_code": "853447718",
            "telephone_number": "928-669-2137",
            "fax_number": "928-669-3131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REVERE",
        "first_name": "GLEN",
        "middle_name": "P",
        "credential": "R.D., C.D.E.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": "473669",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Rascon
• Natalie Nicole Rash
• Raghavendra Singh Rathore
• Heather Elaine Regan, RRT
• Resilient Health, Inc.
• Kimberly A Rice, MD
• Deborrah Sallie Richards, RN
• Rio Vista Surgical Associates P.C.
• Sandra Lee Roach
• Kristina Collette Robins

• Registered Dietitian in Parker, AZ
• Providers in Parker, AZ by specialty
• Registered Dietitian in Arizona

• 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.

Verify at the official NPI Registry.