Samantha G Spain, RD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

L004914 Issued in NC

Practice address

1710 Kernersville Medical Pkwy Ste 101
Kernersville, NC 27284-7156

Phone

(336) 564-4950

Fax

(336) 564-4959

NPI assigned

Jun 28, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: sspain326438@direct.novanthealth.org

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

{
    "created_epoch": "1467072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603670400000",
    "number": "1629429089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447",
            "telephone_number": "336-564-4950",
            "fax_number": "336-564-4959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1710 KERNERSVILLE MEDICAL PKWY STE 101",
            "city": "KERNERSVILLE",
            "state": "NC",
            "postal_code": "272847156",
            "telephone_number": "336-564-4950",
            "fax_number": "336-564-4959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPAIN",
        "first_name": "SAMANTHA",
        "middle_name": "G",
        "credential": "RD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-28",
        "last_updated": "2020-10-26",
        "certification_date": "2020-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NC",
            "license": "L004914",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sspain326438@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "1710 Kernersville Medical Pkwy Ste 101",
            "city": "Kernersville",
            "state": "NC",
            "country_code": "US",
            "postal_code": "272847156",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Registered Dietitian in Kernersville, NC
• Providers in Kernersville, NC by specialty
• Registered Dietitian in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2020; 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.