Gayla B. Glenn, R.D.

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

D0697 Issued in MS

Practice address

117 S 11TH Ave
Laurel, MS 39440-4312

Phone

(601) 425-3033

Fax

(601) 422-0431

NPI assigned

Jun 27, 2005

Reactivated

Nov 12, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1119830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1290124800000",
    "number": "1831195536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 S 11TH AVE",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394404312",
            "telephone_number": "601-425-3033",
            "fax_number": "601-422-0431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 S 11TH AVE",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394404312",
            "telephone_number": "601-425-3033",
            "fax_number": "601-422-0431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLENN",
        "first_name": "GAYLA",
        "middle_name": "B.",
        "name_prefix": "Ms.",
        "credential": "R.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-27",
        "last_updated": "2010-11-19",
        "deactivation_date": "2007-07-17",
        "reactivation_date": "2010-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "MS",
            "license": "D0697",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Registered Dietitian in Laurel, MS
• Providers in Laurel, MS by specialty
• Registered Dietitian in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 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.

Verify at the official NPI Registry.