Active NPI
Kathleen Evans
- Nutrition Education Nutritionist
- Melbourne, FL
National Provider Identifier
1508880865
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nutrition Education Nutritionist
- License
- ND970
- Practice address
- 95 Bulldog Blvd
Ste 101
Melbourne, FL 32901-3332 - Phone
- (321) 722-9731
- Fax
- (321) 308-0496
- NPI assigned
- Jul 27, 2006
- 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 |
|---|---|---|---|---|
| Nutrition Education Nutritionist | 133NN1002X | ND970 | FL | Primary |
Addresses
Primary practice location
95 Bulldog Blvd
Ste 101
Melbourne, FL 32901-3332
Mailing address
95 Bulldog Blvd
Ste 202
Melbourne, FL 32901-3332
Phone (321) 727-2990
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0991-0187 | Other | NATIONAL CERT BOARD FOR DIABETES EDUCATORS | |
| ND970 | Other | FL | DIETITIAN/NUTRITIONIST |
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 |
|---|---|---|---|
| ND970 | FL | MD | Nutrition Education Nutritionist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1330992000000",
"number": "1508880865",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "95 BULLDOG BLVD",
"address_2": "STE 202",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "329013332",
"telephone_number": "321-727-2990",
"fax_number": "321-724-0455"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "95 BULLDOG BLVD",
"address_2": "STE 101",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "329013332",
"telephone_number": "321-722-9731",
"fax_number": "321-308-0496"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EVANS",
"first_name": "KATHLEEN",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-27",
"last_updated": "2012-03-06",
"status": "A"
},
"taxonomies": [
{
"code": "133NN1002X",
"taxonomy_group": "",
"desc": "Nutritionist, Nutrition, Education",
"state": "FL",
"license": "ND970",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NATIONAL CERT BOARD FOR DIABETES EDUCATORS",
"identifier": "0991-0187",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DIETITIAN/NUTRITIONIST",
"identifier": "ND970",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Melbourne, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.