Active NPI
Jennifer Laura Sides, R.D., L.D.
- Registered Dietitian
- Saint Louis, MO
National Provider Identifier
1982751517
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- DT06855
- Practice address
- 12647 Olive Blvd
Suite 600
Saint Louis, MO 63141-6345 - Phone
- (800) 325-3982
- NPI assigned
- Jan 4, 2007
- 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 | DT06855 | TX | Primary |
Addresses
Primary practice location
12647 Olive Blvd
Suite 600
Saint Louis, MO 63141-6345
Mailing address
7828 Pat Booker Rd
Apt. 712
Live Oak, TX 78233-2618
Phone (806) 441-2320
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 |
|---|---|---|---|
| DT06855 | TX | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167868800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1982751517",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7828 PAT BOOKER RD",
"address_2": "APT. 712",
"city": "LIVE OAK",
"state": "TX",
"postal_code": "782332618",
"telephone_number": "806-441-2320"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12647 OLIVE BLVD",
"address_2": "SUITE 600",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631416345",
"telephone_number": "800-325-3982"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIDES",
"first_name": "JENNIFER",
"middle_name": "LAURA",
"credential": "R.D., L.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "TX",
"license": "DT06855",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.