Active NPI
Kathleen Comerford, MS, CNS, LDN
- Nutritionist
- Indianapolis, IN
National Provider Identifier
1578189221
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nutritionist
- License
- 164.007997
- Practice address
- 1075 Broad Ripple Ave Ste 179
Indianapolis, IN 46220-2034 - Phone
- (317) 934-0331
- NPI assigned
- Jun 18, 2020
- Last updated
- Dec 20, 2021
- 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 |
|---|---|---|---|---|
| Nutritionist | 133N00000X | 164.007997 | IL | Primary |
Addresses
Primary practice location
1075 Broad Ripple Ave Ste 179
Indianapolis, IN 46220-2034
Mailing address
1075 Broad Ripple Ave Ste 179
Indianapolis, IN 46220-2034
Phone (317) 934-0331
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)
- Not enrolled
- Credentials
- Certified Nurse Specialist, Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 164.007997 | IL | MD | Nutritionist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1592438400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1639958400000",
"number": "1578189221",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1075 BROAD RIPPLE AVE STE 179",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462202034",
"telephone_number": "317-934-0331"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1075 BROAD RIPPLE AVE STE 179",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462202034",
"telephone_number": "317-934-0331"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COMERFORD",
"first_name": "KATHLEEN",
"credential": "MS, CNS, LDN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-06-18",
"last_updated": "2021-12-20",
"certification_date": "2021-12-15",
"status": "A"
},
"taxonomies": [
{
"code": "133N00000X",
"taxonomy_group": "",
"desc": "Nutritionist",
"state": "IL",
"license": "164.007997",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 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.