MEDICARE: PRIORITY DIETETICS LLC

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	133VN1201X	Obesity and Weight Management Nutrition Registered Dietitian

General Provider Information

NPI Number	:	1811789332
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIORITY DIETETICS LLC

Provider Business Mailing Address
First Line	:	424 WASHINGTON ST STE 9
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-6790
Country	:	US
Telephone Number	:	240-751-7737
Fax Number	:

Provider Business Practice Location Address
First Line	:	424 WASHINGTON ST STE 9
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-6790
Country	:	US
Telephone Number	:	240-751-7737
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BROOKE SIMMONS
Credential	:	RD
Telephone Number	:	240-751-7737

Provider Enumeration Date	:	05/20/2025
Last Update Date	:	05/20/2025

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