My Signature Nutrition, LLC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

DT82055 Issued in TX

Legal business name

MY SIGNATURE NUTRITION, LLC

Practice address

5620 Old Bullard Rd
Suite 125
Tyler, TX 75703-4358

Phone

(903) 312-8906

NPI assigned

Oct 9, 2014

Last updated

Oct 9, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Sara Upson, M.ED, RD, LDNPI 1184983330

Title

Owner

Phone

(903) 312-8906

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Sara Upson, M.ED, RD, LD

  • Registered Dietitian
  • Tyler, TX
  • NPI 1184983330

  Dietitian, Registered

  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1412812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412812800000",
    "number": "1528462223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5620 OLD BULLARD RD",
            "address_2": "SUITE 125",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757034358",
            "telephone_number": "903-312-8906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5620 OLD BULLARD RD",
            "address_2": "SUITE 125",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757034358",
            "telephone_number": "903-312-8906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MY SIGNATURE NUTRITION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-09",
        "last_updated": "2014-10-09",
        "status": "A",
        "authorized_official_last_name": "UPSON",
        "authorized_official_first_name": "SARA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "903-312-8906",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "M.ED, RD, LD"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "TX",
            "license": "DT82055",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Registered Dietitian in Tyler, TX
• Providers in Tyler, TX by specialty
• Registered Dietitian in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.