Medical Nutrition Services, LLC

Primary specialty

NutritionistTaxonomy code 133N00000X

Legal business name

MEDICAL NUTRITION SERVICES, LLC

Practice address

1198 W Kelly LN
Tempe, AZ 85284-3772

Phone

(480) 204-6006

Fax

(480) 436-6006

NPI assigned

Apr 8, 2013

Organization subpart

No

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

Authorized official

Name

Krista M Simonetti, MS, CNS

Title

Owner

Phone

(480) 204-6006

Specialties & licenses 5

Addresses

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

{
    "created_epoch": "1365379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372464000000",
    "number": "1609219872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1198 W KELLY LN",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852843772",
            "telephone_number": "480-204-6006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1198 W KELLY LN",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852843772",
            "telephone_number": "480-204-6006",
            "fax_number": "480-436-6006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL NUTRITION SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-08",
        "last_updated": "2013-06-29",
        "status": "A",
        "authorized_official_last_name": "SIMONETTI",
        "authorized_official_first_name": "KRISTA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-204-6006",
        "authorized_official_credential": "MS, CNS"
    },
    "taxonomies": [
        {
            "code": "133N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nutritionist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "133NN1002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nutritionist, Nutrition, Education",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133VN1004X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered, Nutrition, Pediatric",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133VN1005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered, Nutrition, Renal",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133VN1006X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered, Nutrition, Metabolic",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2013; 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.