Active NPI
Mary H Bohannon, RD LDN
- Registered Dietitian
- Gainesville, FL
National Provider Identifier
1518187749
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- ND00000297
- Practice address
- 4001 Newberry Rd
Suite C IV
Gainesville, FL 32607 - Phone
- (352) 374-4449
- Fax
- (352) 374-4464
- NPI assigned
- Apr 30, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | ND00000297 | FL | Primary |
Addresses
Primary practice location
4001 Newberry Rd
Suite C IV
Gainesville, FL 32607
Mailing address
12208 SW 16TH St
Micanopy, FL 32667
Phone (352) 466-3864
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
- Credentials
- Certified Nurse Specialist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ND00000297 | FL | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177891200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1311120000000",
"number": "1518187749",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12208 SW 16TH ST",
"city": "MICANOPY",
"state": "FL",
"postal_code": "32667",
"telephone_number": "352-466-3864"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4001 NEWBERRY RD",
"address_2": "SUITE C IV",
"city": "GAINESVILLE",
"state": "FL",
"postal_code": "32607",
"telephone_number": "352-374-4449",
"fax_number": "352-374-4464"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOHANNON",
"first_name": "MARY",
"middle_name": "H",
"name_prefix": "Ms.",
"credential": "RD LDN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-30",
"last_updated": "2011-07-20",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "FL",
"license": "ND00000297",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gainesville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.