Leigh Anne Charles, MA,RD, LDN

Key facts

NPI

1497855951

Entity type

Individual (NPI type 1)

Primary specialty

Registered Dietitian 133V00000X

License

L002833 (NC)

Practice address

2230 Horizon CT
Conover, NC 28613-9253

Phone

(828) 228-1027

NPI assigned

Sep 25, 2006

Sex

Female

Sole proprietor

Yes

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.

• Wake Forest University Health Sciences Multi-Specialty Clinic/Center · Winston Salem, NC · NPI 1003803032
  Medicare reassignment NPD NC

Medicare participation

Medicare fee-for-service enrollment

Enrolled in NC

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Master of Arts

State licenses

Practice roles

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 20, 2022.

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650412800000",
    "number": "1497855951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4610 COUNTRY CLUB RD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271043520",
            "telephone_number": "336-716-8232",
            "fax_number": "336-716-8228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2230 HORIZON CT",
            "city": "CONOVER",
            "state": "NC",
            "postal_code": "286139253",
            "telephone_number": "828-228-1027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHARLES",
        "first_name": "LEIGH",
        "middle_name": "ANNE",
        "name_prefix": "Mrs.",
        "credential": "MA,RD, LDN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-25",
        "last_updated": "2022-04-20",
        "certification_date": "2022-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NC",
            "license": "0254",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NC",
            "license": "L002833",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Conover, NC · Registered Dietitian in North Carolina