Active NPI
Phyllis M Woodson, RD
- Registered Dietitian
- Norfolk, VA
National Provider Identifier
1790753382
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- R37612-2
- Practice address
- 855 W Brambleton Ave
Norfolk, VA 23510-1005 - Phone
- (757) 446-5908
- Fax
- (757) 446-7055
- NPI assigned
- Mar 9, 2006
- 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 | R37612-2 | VA | Primary |
Addresses
Primary practice location
855 W Brambleton Ave
Norfolk, VA 23510-1005
Mailing address
PO Box 936
Norfolk, VA 23501-0936
Phone (757) 446-5908
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2116995 | Other | VA | UHC/MAMSI |
| PAR | Other | VA | VIRGINIA PREMIER HEALTH |
| PAR | Other | VA | CORVEL/CORCARE |
| 1790753382 | Medicaid | VA | |
| PAR | Other | VA | MUTLIPLAN |
| PAR | Other | VA | AETNA |
| -033 | Other | VA | TRICARE/CHAMPUS |
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R37612-2 | VA | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141862400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1280966400000",
"number": "1790753382",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 936",
"city": "NORFOLK",
"state": "VA",
"postal_code": "235010936",
"telephone_number": "757-446-5908",
"fax_number": "757-446-7055"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "855 W BRAMBLETON AVE",
"city": "NORFOLK",
"state": "VA",
"postal_code": "235101005",
"telephone_number": "757-446-5908",
"fax_number": "757-446-7055"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOODSON",
"first_name": "PHYLLIS",
"middle_name": "M",
"name_prefix": "Ms.",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-09",
"last_updated": "2010-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "VA",
"license": "R37612-2",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UHC/MAMSI",
"identifier": "2116995",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VIRGINIA PREMIER HEALTH",
"identifier": "PAR",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CORVEL/CORCARE",
"identifier": "PAR",
"state": "VA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1790753382",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MUTLIPLAN",
"identifier": "PAR",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "PAR",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE/CHAMPUS",
"identifier": "-033",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Norfolk, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.