Active NPI
Elaine Patricia Nisonger, RDN, LD
- Registered Dietitian
- Eagle River, AK
National Provider Identifier
1891862801
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 140
- Practice address
- 9713 Chisik Cir
Eagle River, AK 99577-8785 - Phone
- (907) 694-4274
- Fax
- (907) 694-4274
- NPI assigned
- Nov 29, 2006
- 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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 140 | AK | Primary |
Addresses
Primary practice location
9713 Chisik Cir
Eagle River, AK 99577-8785
Mailing address
9713 Chisik Cir
Eagle River, AK 99577-8785
Phone (907) 694-4274
Other practice location 1
Bldg. 600 Richardson Drive
ASYMCA Military WIC Clinic A 121
Ft. Richardson, AK 99505
Phone (907) 384-2033
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 140 | Other | AK | DIETITIAN LICENSE |
| 210317 | Other | AK | DMA CERTIFICATION NUMBER |
| 918893 | Other | AK | RD ID NUMBER |
Other names 1
- Miss Elaine Patricia Coombs
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
- Credentials
- Bachelor of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 140 | AK | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560470400000",
"number": "1891862801",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9713 CHISIK CIR",
"city": "EAGLE RIVER",
"state": "AK",
"postal_code": "995778785",
"telephone_number": "907-694-4274",
"fax_number": "907-694-4274"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9713 CHISIK CIR",
"city": "EAGLE RIVER",
"state": "AK",
"postal_code": "995778785",
"telephone_number": "907-694-4274",
"fax_number": "907-694-4274"
}
],
"practiceLocations": [
{
"address_1": "Bldg. 600 Richardson Drive",
"address_2": "ASYMCA Military WIC Clinic A 121",
"address_purpose": "LOCATION",
"city": "Ft. Richardson",
"state": "AK",
"postal_code": "99505",
"country_code": "US",
"telephone_number": "907-384-2033",
"fax_number": "907-384-2036",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "NISONGER",
"first_name": "ELAINE",
"middle_name": "PATRICIA",
"name_prefix": "Mrs.",
"credential": "RDN, LD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-29",
"last_updated": "2019-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "AK",
"license": "140",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DIETITIAN LICENSE",
"identifier": "140",
"state": "AK"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DMA CERTIFICATION NUMBER",
"identifier": "210317",
"state": "AK"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RD ID NUMBER",
"identifier": "918893",
"state": "AK"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "ELAINE",
"last_name": "COOMBS",
"middle_name": "PATRICIA",
"prefix": "MISS",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Eagle River, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.