Active NPI
Mallory Anne Longwell, MS, RD, LD
- Registered Dietitian
- Austin, TX
National Provider Identifier
1891418547
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- DT87204
- Practice address
- 5225 N Lamar Blvd
Austin, TX 78751-1820 - Phone
- (512) 472-4357
- NPI assigned
- Sep 19, 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 | DT87204 | TX | Primary |
Addresses
Primary practice location
5225 N Lamar Blvd
Austin, TX 78751-1820
Mailing address
2425 Ashdale Dr Apt 40
Austin, TX 78757-8151
Phone (913) 593-1409
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DT87204 | TX | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1663545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1663545600000",
"number": "1891418547",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2425 ASHDALE DR APT 40",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787578151",
"telephone_number": "913-593-1409"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5225 N LAMAR BLVD",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787511820",
"telephone_number": "512-472-4357"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LONGWELL",
"first_name": "MALLORY",
"middle_name": "ANNE",
"name_prefix": "Ms.",
"credential": "MS, RD, LD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-09-19",
"last_updated": "2022-09-19",
"certification_date": "2022-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "TX",
"license": "DT87204",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Austin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 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.