Abby Jo Tibodeau, RD, LD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

3033 Issued in MN

Practice address

1230 E Main St
Mankato, MN 56001-5066

Phone

(507) 625-1811

NPI assigned

Jan 16, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in AZ, GA, NC, TX, WA, WI, IL, ME, MA, AR, DC, NH, NM, NV, MD, IA, OH, NY, FL, PA, ID21 enrollments

Enrollment records 21

Specialty

Registered Dietitian Or Nutrition Professional

Education

Other, 2010

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/19691/brand/1/csg/1/fhir/r4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Season Clinical Care P.a.

  • Registered Dietitian
  • Irving, TX
  • NPI 1649933565

  AR, AZ, DC, Dietitian, Registered, FL, GA, IA, ID, IL, MA, MD, ME, NH, NM, NV, OH, PA, WA, WI

  Medicare reassignment NPD
• Season Medical Care Ny PC

  • Registered Dietitian
  • Brooklyn, NY
  • NPI 1275421810

  Dietitian, Registered

  Medicare reassignment NPD
• Surely Health, Inc.

  • Registered Dietitian
  • Irving, TX
  • NPI 1053078360

  AZ, Dietitian, Registered, GA, NC

  Medicare reassignment NPD
• Uhling Consulting, LLC

  • Registered Dietitian
  • Phoenix, AZ
  • NPI 1609171636

  Dietitian, Registered

  Medicare reassignment NPD
• Marjorie Nolan Cohn LLC

  • Registered Dietitian
  • New York, NY
  • NPI 1760825160

  Dietitian, Registered

  NPD (past)

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

{
    "created_epoch": "1547596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595376000000",
    "number": "1912471665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 MALLARD CT",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560011860",
            "telephone_number": "507-327-7993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1230 E MAIN ST",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560015066",
            "telephone_number": "507-625-1811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIBODEAU",
        "first_name": "ABBY",
        "middle_name": "JO",
        "credential": "RD, LD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-16",
        "last_updated": "2020-07-22",
        "certification_date": "2020-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "MN",
            "license": "3033",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "abbytibodeau@mklt.allscriptsdirect.net",
            "affiliation": "N",
            "endpointDescription": "Mankato Clinic Direct ID, Allscripts Community",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1230 E Main St",
            "city": "Mankato",
            "state": "MN",
            "country_code": "US",
            "postal_code": "560015066",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Thro Company
• Thro Company
• Thro Company
• Angela Throldahl, SLP
• Bonny Rose-Anne Thul, NP
• Tonya Jean Tidwell, PA-C
• Emily Catherine Tiede
• Rachel Dawn Tiede, LMFT
• Thomas James Tieffenbacher, M.A.,L.P.
• Markeita Tiegs

• Registered Dietitian in Mankato, MN
• Providers in Mankato, MN by specialty
• Registered Dietitian in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.