Active NPI
Destiny Nolan, RD
- Registered Dietitian
- Kennesaw, GA
National Provider Identifier
1881344497
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- LD006088
- Practice address
- 1326 Wood Park Dr NW
Kennesaw, GA 30152-4641 - Phone
- (678) 722-1924
- NPI assigned
- Mar 26, 2022
- Last updated
- Mar 26, 2022
- 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 | LD006088 | GA | Primary |
Addresses
Primary practice location
1326 Wood Park Dr NW
Kennesaw, GA 30152-4641
Mailing address
1326 Wood Park Dr NW
Kennesaw, GA 30152-4641
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LD006088 | GA | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1648252800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1648252800000",
"number": "1881344497",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1326 WOOD PARK DR NW",
"city": "KENNESAW",
"state": "GA",
"postal_code": "301524641"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1326 WOOD PARK DR NW",
"city": "KENNESAW",
"state": "GA",
"postal_code": "301524641",
"telephone_number": "678-722-1924"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NOLAN",
"first_name": "DESTINY",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-03-26",
"last_updated": "2022-03-26",
"certification_date": "2021-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "GA",
"license": "LD006088",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kennesaw, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 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.