Misty Marie Davidson, RD, LD
Individual provider Active NPI Registered Dietitian · Troy, MO
NPI 1508569708 · NPPES record last updated Mar 24, 2023
Key facts
- NPI
- 1508569708
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Dietitian 133V00000X
- License
- 2015019220 (MO)
- Practice address
- 456 Bluff Dr
Troy, MO 63379-2040 - Phone
- (573) 338-2953
- NPI assigned
- Mar 24, 2023
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Registered Dietitian Or Nutrition Professional
- Education
- Other, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Nourish, Inc.
Practice addresses (Care Compare)
3724 Jefferson St
Suite 104
Austin, TX 78731-6204
Phone (512) 693-7045
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230620003363 | TX | Practitioner - Registered Dietitian Or Nutrition Professional | 8628436813 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3338 | LA | MD | Registered Dietitian |
| 2015019220 | MO | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nourish, Inc. | Dietitian, Registered | Current |
Accepting new patients |
Locations
4600 E Washington St
Ste 300
Phoenix, AZ 85034
Phone (602) 638-1872
515 S Flower St
#1015
Los Angeles, CA 90071
250 Fillmore St
Unit 150
Denver, CO 80206
Phone (410) 505-0521
100 Cambridge St
Fl 14
Boston, MA 02114
Phone (617) 917-2389
500 Westover Dr
Sanford, NC 27330
Phone (478) 766-4000
10260 SW Greenburg Rd
#4
Portland, OR 97223
Phone (513) 845-1656
3724 Jefferson St
Ste 104
Austin, TX 78731
Phone (512) 399-9039
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 3338 | LA | |
| Registered Dietitian | 133V00000X | 2015019220 | MO | Yes |
Addresses
Primary practice location
456 Bluff Dr
Troy, MO 63379-2040
Mailing address
456 Bluff Dr
Troy, MO 63379-2040
Phone (573) 338-2953
Other providers in Troy, MO
- Counseling for Resolution LLC
- McKenna Lee Courtney
- Cross Couseling & Behavioral Health
- Cuivre Creek Pediatric Dentistry
- Benjamin Cullen
- Melissa Joy Davison
- Kimberly Ann Dejoe
- Kyley Samantha Dermody
- Crystal Louise Diffee
- Heather S Dixon
All providers in Troy, MO · Registered Dietitian in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 24, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.