NPIMap

Organization Active NPI

Practical Nutrition LLC

  • Registered Dietitian
  • Arlington, TX
National Provider Identifier
1972077519
Registry record updated Nov 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
Legal business name
PRACTICAL NUTRITION LLC
Practice address
2911 Medlin Dr
Arlington, TX 76015-2330
Phone
(575) 644-3568
Fax
(817) 476-6133
NPI assigned
Jan 16, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2024

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

Authorized official

Name
Heather Di Stefano, MS, RDNPI 1003067075
Title
Owner
Phone
(682) 999-5835

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered DietitianGroup: 193400000X SINGLE SPECIALTY GROUP 133V00000X Primary

Addresses

Primary practice location

2911 Medlin Dr
Arlington, TX 76015-2330

Mailing address

3401 State Highway 34 S
Greenville, TX 75402-5128
Phone (682) 999-5835

Other practice location 1

41990 Cook St Ste 2008
Palm Desert, CA 92211-6105
Phone (682) 564-2381

Other practice location 2

2005 NE Green Oaks Blvd Ste 150
Arlington, TX 76006-3289
Phone (682) 564-2381

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190715002740 TX Part B Supplier - Clinic/Group Practice 6406181395 Receives reassigned benefits from 4 practitioners
Practice locations: Arlington, TX

National Provider Directory

National Provider Directory

Locations

2911 Medlin Dr
Arlington, TX 76015
Phone (682) 564-2381

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1547596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731542400000",
    "number": "1972077519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3401 STATE HIGHWAY 34 S",
            "city": "GREENVILLE",
            "state": "TX",
            "postal_code": "754025128",
            "telephone_number": "682-999-5835",
            "fax_number": "817-476-6133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2911 MEDLIN DR",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760152330",
            "telephone_number": "575-644-3568",
            "fax_number": "817-476-6133"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "41990 Cook St Ste 2008",
            "address_purpose": "LOCATION",
            "city": "Palm Desert",
            "state": "CA",
            "postal_code": "922116105",
            "country_code": "US",
            "telephone_number": "682-564-2381",
            "fax_number": "817-476-6133",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2005 NE Green Oaks Blvd Ste 150",
            "address_purpose": "LOCATION",
            "city": "Arlington",
            "state": "TX",
            "postal_code": "760063289",
            "country_code": "US",
            "telephone_number": "682-564-2381",
            "fax_number": "817-476-6133",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PRACTICAL NUTRITION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-16",
        "last_updated": "2024-11-14",
        "certification_date": "2024-11-14",
        "status": "A",
        "authorized_official_last_name": "DI STEFANO",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "682-999-5835",
        "authorized_official_credential": "MS, RD"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Arlington, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.