Active NPI
Connor Freed, MS, LD
- Registered Dietitian
- Morgantown, WV
National Provider Identifier
1508692062
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 1558
- Practice address
- 1204 Creekview LN
Morgantown, WV 26508-6269 - Phone
- (043) 893-4916
- NPI assigned
- Sep 11, 2024
- Last updated
- Dec 2, 2024
- Sex
- Male
- 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 | 1558 | WV | Primary |
Addresses
Primary practice location
1204 Creekview LN
Morgantown, WV 26508-6269
Mailing address
943 Maple Dr
Morgantown, WV 26505-2812
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WV
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250219003548 | WV | Practitioner - Registered Dietitian Or Nutrition Professional | 9931629052 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nourish, Inc. | Dietitian, Registered | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1726012800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1733097600000",
"number": "1508692062",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "943 MAPLE DR",
"city": "MORGANTOWN",
"state": "WV",
"postal_code": "265052812"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1204 CREEKVIEW LN",
"city": "MORGANTOWN",
"state": "WV",
"postal_code": "265086269",
"telephone_number": "043-893-4916"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FREED",
"first_name": "CONNOR",
"credential": "MS, LD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-09-11",
"last_updated": "2024-12-02",
"certification_date": "2024-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "WV",
"license": "1558",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Morgantown, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.