Active NPI
Azzairia Jackson, RD
- Registered Dietitian
- Saint Paul, MN
National Provider Identifier
1013775519
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 7808
- Practice address
- 2081 Village LN Apt B5
Saint Paul, MN 55116-3847 - Phone
- (612) 735-1669
- NPI assigned
- Mar 8, 2024
- Last updated
- Mar 8, 2024
- Sex
- Female
- Sole proprietor
- No
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 | 7808 | MN | Primary |
Addresses
Primary practice location
2081 Village LN Apt B5
Saint Paul, MN 55116-3847
Mailing address
2081 Village LN Apt B5
Saint Paul, MN 55116-3847
Phone (612) 735-1669
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 |
|---|---|---|---|
| 7808 | MN | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nourish, Inc. | Dietitian, Registered | Past | Accepting new patients |
Networks
- IL HMO C-SNP
- devoted network organization-1baeae7e-6b6f-49f9-a562-1b2d2e55c806
- TX HMO
- devoted network organization-83621310-88c0-4660-8f8d-b8ea8f4dc04e
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1709856000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1709856000000",
"number": "1013775519",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2081 VILLAGE LN APT B5",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551163847",
"telephone_number": "612-735-1669"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2081 VILLAGE LN APT B5",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551163847",
"telephone_number": "612-735-1669"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "AZZAIRIA",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-03-08",
"last_updated": "2024-03-08",
"certification_date": "2024-03-08",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MN",
"license": "7808",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.