Landry Bateman, RD, LD
Individual provider Active NPI Registered Dietitian · Bowling Green, KY
NPI 1871207613 · NPPES record last updated Dec 18, 2024
Key facts
- NPI
- 1871207613
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Dietitian 133V00000X
- License
- 281279 (KY)
- Practice address
- 207 Traditions Blvd
Bowling Green, KY 42103-7957 - Phone
- (270) 901-3412
- NPI assigned
- Jan 6, 2023
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230921002603 | TN | Practitioner - Registered Dietitian Or Nutrition Professional | 9032563242 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 281279 | KY | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nourish, Inc. | Dietitian, Registered | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 281279 | KY | Yes |
Addresses
Primary practice location
207 Traditions Blvd
Bowling Green, KY 42103-7957
Mailing address
207 Traditions Blvd
Bowling Green, KY 42103-7957
Phone (330) 844-7215
Other providers in Bowling Green, KY
- Dennis Bartsch
- Sanjana Basavanagowda Patil
- Casandra Denise Baseheart
- Soney Basnyat
- Kristin K Bateman
- John T Bates
- Amy Battaile
- Lauren Batten
- Sophia Baumgarten
- Vicki Beach
All providers in Bowling Green, KY · Registered Dietitian in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 18, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.