Active NPI
Sandra Lee Johnson, RD, LD, CDCES
- Registered Dietitian
- Conroe, TX
National Provider Identifier
1760236087
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86169488
- Practice address
- 2320 Hagerman Rd
Conroe, TX 77384-3547 - Phone
- (281) 217-4699
- NPI assigned
- Apr 15, 2024
- Last updated
- Apr 15, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 86169488 | TX | Primary |
Addresses
Primary practice location
2320 Hagerman Rd
Conroe, TX 77384-3547
Mailing address
2320 Hagerman Rd
Conroe, TX 77384-3547
Phone (281) 217-4699
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86169488 | TX | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nourish, Inc. | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1713139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1713139200000",
"number": "1760236087",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2320 HAGERMAN RD",
"city": "CONROE",
"state": "TX",
"postal_code": "773843547",
"telephone_number": "281-217-4699"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2320 HAGERMAN RD",
"city": "CONROE",
"state": "TX",
"postal_code": "773843547",
"telephone_number": "281-217-4699"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "SANDRA",
"middle_name": "LEE",
"name_prefix": "Mrs.",
"credential": "RD, LD, CDCES",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-04-15",
"last_updated": "2024-04-15",
"certification_date": "2024-04-13",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "TX",
"license": "86169488",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Conroe, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 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.