Provider Demographics
NPI:1992464184
Name:THOMAS J HELLYER DIETITIAN & ASSOCIATES LLC
Entity type:Organization
Organization Name:THOMAS J HELLYER DIETITIAN & ASSOCIATES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:HELLYER
Authorized Official - Suffix:JR
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:304-415-1384
Mailing Address - Street 1:PO BOX 778427
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89077-8427
Mailing Address - Country:US
Mailing Address - Phone:725-529-7989
Mailing Address - Fax:702-920-9966
Practice Address - Street 1:10120 S EASTERN AVE STE 115
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3952
Practice Address - Country:US
Practice Address - Phone:725-529-7989
Practice Address - Fax:702-920-9966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-15
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1992464184Medicaid
NV1730655903Medicaid