Active NPI
Tylor John Sousa, RD
- Registered Dietitian
- Festus, MO
National Provider Identifier
1912644857
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 2022015922
- Practice address
- 1400 US Highway 61
Festus, MO 63028-4100 - Phone
- (636) 933-1680
- NPI assigned
- May 12, 2022
- Last updated
- May 12, 2022
- Sex
- Male
- 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 | 2022015922 | MO | Primary |
Addresses
Primary practice location
1400 US Highway 61
Festus, MO 63028-4100
Mailing address
1400 US Highway 61
Festus, MO 63028-4100
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2022015922 | MO | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1652313600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1652313600000",
"number": "1912644857",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1400 US HIGHWAY 61",
"city": "FESTUS",
"state": "MO",
"postal_code": "630284100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1400 US HIGHWAY 61",
"city": "FESTUS",
"state": "MO",
"postal_code": "630284100",
"telephone_number": "636-933-1680"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOUSA",
"first_name": "TYLOR",
"middle_name": "JOHN",
"name_prefix": "Mr.",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-05-12",
"last_updated": "2022-05-12",
"certification_date": "2022-03-10",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MO",
"license": "2022015922",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Festus, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 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.