Active NPI
Jolie Jackson, MS, RDN, LD
- Registered Dietitian
- Conway, AR
National Provider Identifier
1093442154
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86198172
- Practice address
- 2302 College Ave
Conway, AR 72034-6297 - Phone
- (501) 513-5248
- NPI assigned
- Aug 8, 2022
- 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 | 86198172 | AR | Primary |
Addresses
Primary practice location
2302 College Ave
Conway, AR 72034-6297
Mailing address
2302 College Ave
Conway, AR 72034-6297
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86198172 | AR | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1659916800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1659916800000",
"number": "1093442154",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2302 COLLEGE AVE",
"city": "CONWAY",
"state": "AR",
"postal_code": "720346297"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2302 COLLEGE AVE",
"city": "CONWAY",
"state": "AR",
"postal_code": "720346297",
"telephone_number": "501-513-5248"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "JOLIE",
"credential": "MS, RDN, LD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-08-08",
"last_updated": "2022-08-08",
"certification_date": "2022-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "AR",
"license": "86198172",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Conway, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.