Active NPI
Tessa Shultice, RD, LMNT
- Registered Dietitian
- Sioux City, IA
National Provider Identifier
1609236207
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 1191
- Practice address
- 3301 Gordon Dr
Sioux City, IA 51105-3708 - Phone
- (515) 480-4316
- NPI assigned
- Feb 25, 2016
- Sex
- Female
- Sole proprietor
- No
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 | 1191 | NE | Primary |
Addresses
Primary practice location
3301 Gordon Dr
Sioux City, IA 51105-3708
Mailing address
3301 Gordon Dr.
Sioux City, IA 51105
Phone (515) 480-4316
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1191 | NE | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1456358400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1485734400000",
"number": "1609236207",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3301 GORDON DR.",
"city": "SIOUX CITY",
"state": "IA",
"postal_code": "51105",
"telephone_number": "515-480-4316"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3301 GORDON DR",
"city": "SIOUX CITY",
"state": "IA",
"postal_code": "511053708",
"telephone_number": "515-480-4316"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHULTICE",
"first_name": "TESSA",
"name_prefix": "Miss",
"credential": "RD, LMNT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-02-25",
"last_updated": "2017-01-30",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NE",
"license": "1191",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sioux City, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.