Active NPI
Teresa Ellen Kisanuki
- Registered Dietitian
- Redding, CA
National Provider Identifier
1508364274
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 804167
- Practice address
- 3400 Knighton Rd
Redding, CA 96002-9657 - Phone
- (530) 224-3815
- NPI assigned
- Jan 29, 2018
- 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 | 804167 | CA | Primary |
Addresses
Primary practice location
3400 Knighton Rd
Redding, CA 96002-9657
Mailing address
3400 Knighton Rd
Redding, CA 96002-9657
Phone (530) 224-3815
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 804167 | CA | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1517184000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1517184000000",
"number": "1508364274",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3400 KNIGHTON RD",
"city": "REDDING",
"state": "CA",
"postal_code": "960029657",
"telephone_number": "530-224-3815"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3400 KNIGHTON RD",
"city": "REDDING",
"state": "CA",
"postal_code": "960029657",
"telephone_number": "530-224-3815"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KISANUKI",
"first_name": "TERESA",
"middle_name": "ELLEN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-01-29",
"last_updated": "2018-01-29",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "CA",
"license": "804167",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Redding, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.