Active NPI
Samantha Leigh White, MCN, RDN
- Registered Dietitian
- Sundance, WY
National Provider Identifier
1740915800
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86172305
- Practice address
- 713 E Oak St
Sundance, WY 82729-5172 - Phone
- (307) 283-3501
- Fax
- (307) 283-3506
- NPI assigned
- Jul 21, 2022
- Last updated
- Dec 9, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 431 | WY | |
| Registered Dietitian | 133V00000X | 86172305 | CO | Primary |
Addresses
Primary practice location
713 E Oak St
Sundance, WY 82729-5172
Mailing address
PO Box 1134
Sundance, WY 82729-1134
Phone (720) 648-2211
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 |
|---|---|---|---|
| 86172305 | CO | MD | Registered Dietitian |
| 431 | WY | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1658361600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1733702400000",
"number": "1740915800",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1134",
"city": "SUNDANCE",
"state": "WY",
"postal_code": "827291134",
"telephone_number": "720-648-2211"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "713 E OAK ST",
"city": "SUNDANCE",
"state": "WY",
"postal_code": "827295172",
"telephone_number": "307-283-3501",
"fax_number": "307-283-3506"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHITE",
"first_name": "SAMANTHA",
"middle_name": "LEIGH",
"credential": "MCN, RDN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-07-21",
"last_updated": "2024-12-09",
"certification_date": "2024-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "WY",
"license": "431",
"primary": false
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "CO",
"license": "86172305",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sundance, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.