Nourished Life Nutrition, PLLC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

Legal business name

NOURISHED LIFE NUTRITION, PLLC

Practice address

4801 Joyce PL
Liverpool, NY 13090-6911

Phone

(315) 528-4711

NPI assigned

Jan 28, 2021

Organization subpart

No

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

Authorized official

Name

Mrs. Brooke Briscoe, MS, RD, CDN

Title

Registered Dietitian

Phone

(315) 528-4711

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brooke Ann Marie Decelles, MS, RD, CDN

  • Registered Dietitian
  • Potsdam, NY
  • NPI 1770171191

  Dietitian, Registered

  Medicare reassignment NPD
• Susan Mitchell, PTGCS

  • Physical Therapist
  • Annapolis, MD
  • NPI 1235325424
  NPD (past)

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

{
    "created_epoch": "1611792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611792000000",
    "number": "1891386371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4801 JOYCE PL",
            "city": "LIVERPOOL",
            "state": "NY",
            "postal_code": "130906911",
            "telephone_number": "315-528-4711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4801 JOYCE PL",
            "city": "LIVERPOOL",
            "state": "NY",
            "postal_code": "130906911",
            "telephone_number": "315-528-4711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOURISHED LIFE NUTRITION, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-28",
        "last_updated": "2021-01-28",
        "certification_date": "2021-01-28",
        "status": "A",
        "authorized_official_last_name": "BRISCOE",
        "authorized_official_first_name": "BROOKE",
        "authorized_official_title_or_position": "REGISTERED DIETITIAN",
        "authorized_official_telephone_number": "315-528-4711",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MS, RD, CDN"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Registered Dietitian in Liverpool, NY
• Providers in Liverpool, NY by specialty
• Registered Dietitian in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.