MEDICARE: MS. EMILY ROSE CONYERS MS, RDN, CSR, LD/N

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133VN1501X	Sports Dietetics Nutrition Registered Dietitian	ND7660	FL
2	133N00000X	Nutritionist	LD006417IU	GA
3	133NN1002X	Nutrition Education Nutritionist	ND7660	FL
4	133N00000X	Nutritionist	ND7660	FL
5	133V00000X	Registered Dietitian	LD006417IU	GA
6	133V00000X	Registered Dietitian	ND7660	FL
7	133VN1201X	Obesity and Weight Management Nutrition Registered Dietitian	ND7660	FL
8	133VN1005X	Renal Nutrition Registered Dietitian	LD006417IU	GA
9	133VN1005X	Renal Nutrition Registered Dietitian	ND7660	FL
10	133VN1101X	Gerontological Nutrition Registered Dietitian	ND7660	FL
11	133VN1201X	Obesity and Weight Management Nutrition Registered Dietitian	LD006417IU	GA

General Provider Information

NPI Number	:	1811474695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EMILY ROSE CONYERS MS, RDN, CSR, LD/N

Provider Business Mailing Address
First Line	:	12866 DAYBREAK CT E
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-7095
Country	:	US
Telephone Number	:	904-497-0401
Fax Number	:	833-773-1288

Provider Business Practice Location Address
First Line	:	12866 DAYBREAK CT E
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-7095
Country	:	US
Telephone Number	:	904-497-0401
Fax Number	:	833-773-1288

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2018
Last Update Date	:	06/06/2026

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