Howard William Edmiston IV, MS, RD, LD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

LD-1166 Issued in NM

Practice address

117 Alamo Dr
Ruidoso, NM 88345-7253

Phone

(910) 476-1822

NPI assigned

Jul 5, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Jake Edmiston Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1625443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625443200000",
    "number": "1578134243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 ALAMO DR",
            "city": "RUIDOSO",
            "state": "NM",
            "postal_code": "883457253",
            "telephone_number": "910-476-1822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 ALAMO DR",
            "city": "RUIDOSO",
            "state": "NM",
            "postal_code": "883457253",
            "telephone_number": "910-476-1822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDMISTON",
        "first_name": "HOWARD",
        "middle_name": "WILLIAM",
        "name_suffix": "IV",
        "credential": "MS, RD, LD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-07-05",
        "last_updated": "2021-07-05",
        "certification_date": "2021-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NM",
            "license": "LD-1166",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JAKE",
            "last_name": "EDMISTON",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Clifton Christopher Duncan, CNP
• Eleanor Suzanne Dunn, RN
• Russell M Easter
• Ann Eby, BMS
• Alisha Little Edmiston, MSW, LCSW
• Kristi Lynn Espinosa, R.PH.
• Mary L Estes, CFNP
• Leanne Eulett
• Cory Everett
• Clara Farah

• Registered Dietitian in Ruidoso, NM
• Providers in Ruidoso, NM by specialty
• Registered Dietitian in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2021; 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.