Active NPI
Angela Lynn Thomason, RD
- Pediatric Nutrition Registered Dietitian
- Belleville, IL
National Provider Identifier
1760660823
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nutrition Registered Dietitian
- License
- 164.003677
- Practice address
- 405 Polk St
Belleville, IL 62220-2441 - Phone
- (618) 239-0553
- NPI assigned
- Jan 31, 2008
- 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 |
|---|---|---|---|---|
| Pediatric Nutrition Registered Dietitian | 133VN1004X | 164.003677 | IL | Primary |
Addresses
Primary practice location
405 Polk St
Belleville, IL 62220-2441
Mailing address
405 Polk St
Belleville, IL 62220-2441
Phone (618) 239-0553
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 |
|---|---|---|---|
| 164.003677 | IL | MD | Pediatric Nutrition Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1201737600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1257811200000",
"number": "1760660823",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "405 POLK ST",
"city": "BELLEVILLE",
"state": "IL",
"postal_code": "622202441",
"telephone_number": "618-239-0553"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "405 POLK ST",
"city": "BELLEVILLE",
"state": "IL",
"postal_code": "622202441",
"telephone_number": "618-239-0553"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THOMASON",
"first_name": "ANGELA",
"middle_name": "LYNN",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-01-31",
"last_updated": "2009-11-10",
"status": "A"
},
"taxonomies": [
{
"code": "133VN1004X",
"taxonomy_group": "",
"desc": "Dietitian, Registered, Nutrition, Pediatric",
"state": "IL",
"license": "164.003677",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Belleville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.