Haley Nichole Goodfellow, RD, LDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

164008029 Issued in IL

Practice address

60 S State Route 157
Edwardsville, IL 62025-3846

Phone

(618) 655-8147

NPI assigned

Jul 13, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Specialty

Registered Dietitian Or Nutrition Professional

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Nourish, Inc.Group PAC ID 1557724937, 288 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Nourish, Inc.

  • Registered Dietitian
  • Austin, TX
  • NPI 1558097824

  Dietitian, Registered

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1594598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594598400000",
    "number": "1952929283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "213 LONGVIEW DR",
            "city": "COLUMBIA",
            "state": "IL",
            "postal_code": "622362079",
            "telephone_number": "618-531-6029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 S STATE ROUTE 157",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620253846",
            "telephone_number": "618-655-8147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODFELLOW",
        "first_name": "HALEY",
        "middle_name": "NICHOLE",
        "credential": "RD, LDN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-13",
        "last_updated": "2020-07-13",
        "certification_date": "2020-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "MO",
            "license": "2020013164",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "IL",
            "license": "164008029",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristie Goeckner, MSN, RN
• Shandra Dawn Goersch, MSN, RN
• Stephanie R Goggin, OD
• Bryan Gomez, RBT
• Sabrina Gomez
• Daniel D Goran, M.D.
• Cassandra Gordon, OTR/L
• Morgan Graham, BEHAVIOR TECHNICIAN
• Grand View Dental Arts, LLC (Borden Dental Arts)
• Lonn J Grandia, MD

• Registered Dietitian in Edwardsville, IL
• Providers in Edwardsville, IL by specialty
• Registered Dietitian in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 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.