Michelle Gautreaux, RDN/LDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

ND3408 Issued in FL

Practice address

325 MDG
340 Magnolia Circle
Tyndall Afb, FL 32403

Phone

(850) 283-3826

NPI assigned

Jun 12, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560816000000",
    "number": "1790727865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 MDG",
            "address_2": "340 MAGNOLIA CIRCLE",
            "city": "TYNDALL AFB",
            "state": "FL",
            "postal_code": "32403",
            "telephone_number": "850-283-3826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 MDG",
            "address_2": "340 MAGNOLIA CIRCLE",
            "city": "TYNDALL AFB",
            "state": "FL",
            "postal_code": "32403",
            "telephone_number": "850-283-3826"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAUTREAUX",
        "first_name": "MICHELLE",
        "name_prefix": "Ms.",
        "credential": "RDN/LDN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-12",
        "last_updated": "2019-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "FL",
            "license": "ND3408",
            "primary": true
        },
        {
            "code": "133N00000X",
            "taxonomy_group": "",
            "desc": "Nutritionist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shauna M. Ezell, PHD, LCSW
• Tyler Faulkner, LAT, ATC, CES
• Zachary Flink, D.D.S.
• Timothy Gallagher, LCSW
• Mordecai Christopher Garcia
• Pamela Suzanne Gilley, LCSW
• Dominique D. Gougis, PSY.D.
• Jimbell Gray, IDMT
• Nicholas Marks Grunewald, PHARMD
• Thomas Haney, IDMT

• Registered Dietitian in Tyndall Afb, FL
• Providers in Tyndall Afb, FL by specialty
• Registered Dietitian in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.