Active NPI
Katelyn Rose Nicholson, RDN
- Metabolic Nutrition Registered Dietitian
- Clear Lake, IA
National Provider Identifier
1841933025
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Metabolic Nutrition Registered Dietitian
- License
- 079235
- Practice address
- 1302 8TH Ave S
Clear Lake, IA 50428-2610 - Phone
- (651) 302-9433
- NPI assigned
- Apr 15, 2022
- 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 |
|---|---|---|---|---|
| Metabolic Nutrition Registered Dietitian | 133VN1006X | 079235 | IA | Primary |
Addresses
Primary practice location
1302 8TH Ave S
Clear Lake, IA 50428-2610
Mailing address
1302 8TH Ave S
Clear Lake, IA 50428-2610
Phone (651) 302-9433
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 |
|---|---|---|---|
| 079235 | IA | MD | Metabolic Nutrition Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1649980800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1649980800000",
"number": "1841933025",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1302 8TH AVE S",
"city": "CLEAR LAKE",
"state": "IA",
"postal_code": "504282610",
"telephone_number": "651-302-9433"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1302 8TH AVE S",
"city": "CLEAR LAKE",
"state": "IA",
"postal_code": "504282610",
"telephone_number": "651-302-9433"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLSON",
"first_name": "KATELYN",
"middle_name": "ROSE",
"credential": "RDN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-04-15",
"last_updated": "2022-04-15",
"certification_date": "2022-04-15",
"status": "A"
},
"taxonomies": [
{
"code": "133VN1006X",
"taxonomy_group": "",
"desc": "Dietitian, Registered, Nutrition, Metabolic",
"state": "IA",
"license": "079235",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clear Lake, IA
- Molencamp Physical Therapy and Wellness
- Megan Moore, CCC-SLP
- Mr Pharmacy LLC (Clear Lake Pharmacy)
- Mr Pharmacy LLC (Clear Lake LTC Pharmacy)
- Robin Sue Mulvey, DPT
- Kelly Nieman, ARNP
- North Iowa Mercy Clinics (MercyOne Clear Lake Pediatric & Adolescent Clinic)
- North Iowa Mercy Clinics (MercyOne Clear Lake Family Medicine)
- North Shore Chiropractic, PC
- Jenna Olson, PTA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.