Active NPI
Cleanne Johnson, RD,CD
- Registered Dietitian
- Pasco, WA
National Provider Identifier
1982005732
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- DI60470392
- Practice address
- 520 N 4TH Ave
Pasco, WA 99301-5257 - Phone
- (509) 547-7704
- Fax
- (509) 542-3053
- NPI assigned
- Sep 11, 2014
- Sex
- Female
- Sole proprietor
- Yes
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 | DI60470392 | WA | Primary |
Addresses
Primary practice location
520 N 4TH Ave
Pasco, WA 99301-5257
Mailing address
605 Pradera CT
Pasco, WA 99301-4619
Phone (509) 542-3052
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DI60470392 | Other | WA | DIETITIAN CERTIFICATION |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221026001091 | NY | Practitioner - Registered Dietitian Or Nutrition Professional | 9931575362 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DI60470392 | WA | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1410393600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1410393600000",
"number": "1982005732",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "605 PRADERA CT",
"city": "PASCO",
"state": "WA",
"postal_code": "993014619",
"telephone_number": "509-542-3052",
"fax_number": "509-542-3053"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "520 N 4TH AVE",
"city": "PASCO",
"state": "WA",
"postal_code": "993015257",
"telephone_number": "509-547-7704",
"fax_number": "509-542-3053"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "CLEANNE",
"name_prefix": "Mrs.",
"credential": "RD,CD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-09-11",
"last_updated": "2014-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "WA",
"license": "DI60470392",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DIETITIAN CERTIFICATION",
"identifier": "DI60470392",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pasco, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2014; 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.