Tatem Johnston
Individual provider Active NPI Registered Dietitian · Glendale, AZ
NPI 1740134287 · NPPES record last updated Feb 23, 2026
Key facts
- NPI
- 1740134287
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Dietitian 133V00000X
- License
- 86392735 (AZ)
- Practice address
- 18001 N 79TH Ave Ste A12
Glendale, AZ 85308-8398 - Phone
- (623) 399-6825
- Fax
- (623) 505-3474
- NPI assigned
- Feb 23, 2026
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Registered Dietitian Or Nutrition Professional
- Education
- Other, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Am Nutrition Services
Practice addresses (Care Compare)
18001 N 79TH Ave
Suite A12
Glendale, AZ 85308-8398
Phone (623) 399-6825
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260310001029 | AZ | Practitioner - Registered Dietitian Or Nutrition Professional | 6709369606 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86392735 | AZ | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Am Nutrition Services | Dietitian, Registered | Current |
Accepting new patients |
Locations
18001 N 79th Ave
Ste A12
Glendale, AZ 85308
Phone (623) 321-5380
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 86392735 | AZ | Yes |
Addresses
Primary practice location
18001 N 79TH Ave Ste A12
Glendale, AZ 85308-8398
Mailing address
18001 N 79TH Ave Ste A12
Glendale, AZ 85308-8398
Phone (623) 399-6825
Other providers in Glendale, AZ
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- Susan Elizabeth Johnson
- Traci Johnson
- Elaine D Johnsonsiekmann
- Madeline M Johnston
- Christine Joiner
- Joint Healing Operations
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- Mumbi Jonason
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All providers in Glendale, AZ · Registered Dietitian in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 23, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.