Libby Ann Dominik, R.D.
Individual provider Active NPI Registered Dietitian · Augusta, MO
NPI 1952957045 · NPPES record last updated Aug 14, 2019
Key facts
- NPI
- 1952957045
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Dietitian 133V00000X
- License
- 850733 (MO)
- Practice address
- 4386 Cappeln Osage Rd
Augusta, MO 63332-1118 - Phone
- (636) 459-7273
- NPI assigned
- Aug 14, 2019
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 850733 | MO | MD | Registered Dietitian |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 850733 | MO | Yes |
Addresses
Primary practice location
4386 Cappeln Osage Rd
Augusta, MO 63332-1118
Mailing address
4386 Cappeln Osage Rd
Augusta, MO 63332-1118
Phone (636) 459-7273
Other practice location 1
509 W 18th St
Hermann, MO 65041
Phone (573) 486-2191
Other providers in Augusta, MO
All providers in Augusta, MO · Registered Dietitian in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 14, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.