Active NPI
Christen Simone Miller, RD
- Registered Dietitian
- Kennesaw, GA
National Provider Identifier
1770058745
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- LD003253
- Practice address
- 1395 Raven Rock TRL NW
Kennesaw, GA 30152-7690 - Phone
- (770) 714-5155
- NPI assigned
- Oct 5, 2018
- 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 | LD003253 | GA | Primary |
Addresses
Primary practice location
1395 Raven Rock TRL NW
Kennesaw, GA 30152-7690
Mailing address
1395 Raven Rock TRL NW
Kennesaw, GA 30152-7690
Phone (770) 714-5155
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 |
|---|---|---|---|
| LD003253 | GA | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dietitian in Your Kitchen | Dietitian, Registered | Past | Accepting new patients |
| Fig Health, Inc | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1538697600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1538697600000",
"number": "1770058745",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1395 RAVEN ROCK TRL NW",
"city": "KENNESAW",
"state": "GA",
"postal_code": "301527690",
"telephone_number": "770-714-5155"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1395 RAVEN ROCK TRL NW",
"city": "KENNESAW",
"state": "GA",
"postal_code": "301527690",
"telephone_number": "770-714-5155"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLER",
"first_name": "CHRISTEN",
"middle_name": "SIMONE",
"name_prefix": "Mrs.",
"credential": "RD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-10-05",
"last_updated": "2018-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dietitian, Registered",
"state": "GA",
"license": "LD003253",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kennesaw, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.