Active NPI
Miranda Robertson Reynolds, RD
- Registered Dietitian
- Salt Lake City, UT
National Provider Identifier
1750005393
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- Practice address
- 804 E Cedar Pine CT Apt 21
Salt Lake City, UT 84106-4605 - Phone
- (208) 260-2467
- NPI assigned
- Sep 27, 2022
- 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 | Primary |
Addresses
Primary practice location
804 E Cedar Pine CT Apt 21
Salt Lake City, UT 84106-4605
Mailing address
804 E Cedar Pine CT Apt 21
Salt Lake City, UT 84106-4605
Phone (208) 260-2467
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1664236800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1664236800000",
"number": "1750005393",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "804 E CEDAR PINE CT APT 21",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841064605",
"telephone_number": "208-260-2467"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "804 E CEDAR PINE CT APT 21",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841064605",
"telephone_number": "208-260-2467"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REYNOLDS",
"first_name": "MIRANDA",
"middle_name": "ROBERTSON",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-09-27",
"last_updated": "2022-09-27",
"certification_date": "2022-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salt Lake City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.