Active NPI
Bailey Personette, RD, CD
- Registered Dietitian
- Mishawaka, IN
National Provider Identifier
1972149862
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86067213
- Practice address
- 1540 Trinity PL
Mishawaka, IN 46545-5006 - Phone
- (574) 272-9000
- NPI assigned
- Nov 26, 2019
- 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 | 86067213 | IN | Primary |
Addresses
Primary practice location
1540 Trinity PL
Mishawaka, IN 46545-5006
Mailing address
5409 Osage Lake Dr Apt 2a
Mishawaka, IN 46545-1288
Phone (574) 261-2035
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 |
|---|---|---|---|
| 86067213 | IN | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nourish, Inc. | Dietitian, Registered | Past | Accepting new patients |
| Marjorie Nolan Cohn LLC | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 2
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1574726400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1574726400000",
"number": "1972149862",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5409 OSAGE LAKE DR APT 2A",
"city": "MISHAWAKA",
"state": "IN",
"postal_code": "465451288",
"telephone_number": "574-261-2035"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1540 TRINITY PL",
"city": "MISHAWAKA",
"state": "IN",
"postal_code": "465455006",
"telephone_number": "574-272-9000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PERSONETTE",
"first_name": "BAILEY",
"credential": "RD, CD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-11-26",
"last_updated": "2019-11-26",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IN",
"license": "86067213",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mishawaka, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.