Active NPI
Charisse L Holiday, RD
- Registered Dietitian
- Phoenix, AZ
National Provider Identifier
1932271855
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 940629
- Practice address
- 4212 N 16TH St
Phoenix, AZ 85016-5319 - Phone
- (602) 263-1200
- NPI assigned
- Nov 15, 2006
- 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 | 940629 | IL | Primary |
Addresses
Primary practice location
4212 N 16TH St
Phoenix, AZ 85016-5319
Mailing address
PNC Bank Pimc
P.O. Box 31001-0698
Pasadena, CA 91110-0698
Phone (602) 263-1200
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 940629 | IL | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163548800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1421280000000",
"number": "1932271855",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PNC BANK PIMC",
"address_2": "P.O. BOX 31001-0698",
"city": "PASADENA",
"state": "CA",
"postal_code": "911100698",
"telephone_number": "602-263-1200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4212 N 16TH ST",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850165319",
"telephone_number": "602-263-1200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLIDAY",
"first_name": "CHARISSE",
"middle_name": "L",
"name_prefix": "Ms.",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-15",
"last_updated": "2015-01-15",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IL",
"license": "940629",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.