Ellen Easley Wallace, CDE, RD, LD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

D1317 Issued in MS

Practice address

103 Starr Ave Apt 66
Starkville, MS 39759-4058

Phone

(662) 418-1184

NPI assigned

May 10, 2011

Sex

Female

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

• Miss Ellen Jane Easley Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1304985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1304985600000",
    "number": "1700178779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5333",
            "city": "MISSISSIPPI STATE",
            "state": "MS",
            "postal_code": "397625333",
            "telephone_number": "662-418-1184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 STARR AVE APT 66",
            "city": "STARKVILLE",
            "state": "MS",
            "postal_code": "397594058",
            "telephone_number": "662-418-1184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "ELLEN",
        "middle_name": "EASLEY",
        "name_prefix": "Mrs.",
        "credential": "CDE, RD, LD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-05-10",
        "last_updated": "2011-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "MS",
            "license": "D1317",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELLEN",
            "last_name": "EASLEY",
            "middle_name": "JANE",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Harrison Carroll Walker Jr., D.D.S., P.A.
• Patrick James Walker
• Charles Edward Wall Jr., MD
• Clara Bailey Wallace, DC
• Codi Labrina Wallace, LPC
• Jean W Walrath, LPO LMFT MED
• Adam Wansley, PHARMD
• Warner Family Dentistry, LLC
• Lindsey Hill Warner, D.M.D.
• We Care Home Care Agency,LLC

• Registered Dietitian in Starkville, MS
• Providers in Starkville, MS by specialty
• Registered Dietitian in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2011; 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.