Active NPI
Brenda Pendarvis, R.D.
- Nutritionist
- Moore, OK
National Provider Identifier
1508262494
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nutritionist
- Practice address
- 12505 Barnes Ter
Moore, OK 73170-3408 - Phone
- (405) 380-3031
- NPI assigned
- Nov 5, 2014
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nutritionist | 133N00000X | Primary | ||
| Registered Dietitian | 133V00000X | LD1295 | OK | |
| Renal Nutrition Registered Dietitian | 133VN1005X |
Addresses
Primary practice location
12505 Barnes Ter
Moore, OK 73170-3408
Mailing address
12505 Barnes Ter
Moore, OK 73170-3408
Phone (405) 380-3031
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| LD1295 | Other | OK | LICENSED DIETITIAN |
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 |
|---|---|---|---|
| LD1295 | OK | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1415145600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1415145600000",
"number": "1508262494",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12505 BARNES TER",
"city": "MOORE",
"state": "OK",
"postal_code": "731703408",
"telephone_number": "405-380-3031"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12505 BARNES TER",
"city": "MOORE",
"state": "OK",
"postal_code": "731703408",
"telephone_number": "405-380-3031"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENDARVIS",
"first_name": "BRENDA",
"credential": "R.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-11-05",
"last_updated": "2014-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "133N00000X",
"taxonomy_group": "",
"desc": "Nutritionist",
"state": null,
"license": null,
"primary": true
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "OK",
"license": "LD1295",
"primary": false
},
{
"code": "133VN1005X",
"taxonomy_group": "",
"desc": "Dietitian, Registered, Nutrition, Renal",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSED DIETITIAN",
"identifier": "LD1295",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Moore, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.