Active NPI
Earnestine D Jackson, MS, RDN, LD
- Registered Dietitian
- Garland, TX
National Provider Identifier
1104418672
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86174756
- Practice address
- 250 N 5TH St Apt 2411
Garland, TX 75040-6355 - Phone
- (214) 417-3836
- NPI assigned
- Feb 6, 2021
- 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 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nutritionist | 133N00000X | |||
| Nutrition Education Nutritionist | 133NN1002X | |||
| Obesity and Weight Management Nutrition Registered Dietitian | 133VN1201X | |||
| Specialist | 174400000X | |||
| Registered Dietitian | 133V00000X | 86174756 | TX | Primary |
Addresses
Primary practice location
250 N 5TH St Apt 2411
Garland, TX 75040-6355
Mailing address
250 N 5TH St Apt 2411
Garland, TX 75040-6355
Phone (214) 417-3836
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)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86174756 | TX | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mobile Medical Consultants, PLLC | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- General Practice Physician
- Dallas, TX
- NPI 1346839859
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1612569600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1612569600000",
"number": "1104418672",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "250 N 5TH ST APT 2411",
"city": "GARLAND",
"state": "TX",
"postal_code": "750406355",
"telephone_number": "214-417-3836"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "250 N 5TH ST APT 2411",
"city": "GARLAND",
"state": "TX",
"postal_code": "750406355",
"telephone_number": "214-417-3836"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "EARNESTINE",
"middle_name": "D",
"credential": "MS, RDN, LD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-02-06",
"last_updated": "2021-02-06",
"certification_date": "2021-02-06",
"status": "A"
},
"taxonomies": [
{
"code": "133N00000X",
"taxonomy_group": "",
"desc": "Nutritionist",
"state": null,
"license": null,
"primary": false
},
{
"code": "133NN1002X",
"taxonomy_group": "",
"desc": "Nutritionist, Nutrition, Education",
"state": null,
"license": null,
"primary": false
},
{
"code": "133VN1201X",
"taxonomy_group": "",
"desc": "Dietitian, Registered, Nutrition, Obesity and Weight Management",
"state": null,
"license": null,
"primary": false
},
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": null,
"license": null,
"primary": false
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "TX",
"license": "86174756",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Garland, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.