Active NPI
Jacqueline Mary Maillet, RD
- Registered Dietitian
- Great Falls, MT
National Provider Identifier
1104802537
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 439
- Practice address
- 468 74TH St N
Malmstrom AFB, Health and Wellness Center
Great Falls, MT 59402-6780 - Phone
- (406) 731-2404
- NPI assigned
- Dec 18, 2005
- 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 | 439 | MT | Primary |
Addresses
Primary practice location
468 74TH St N
Malmstrom AFB, Health and Wellness Center
Great Falls, MT 59402-6780
Mailing address
12647 Olive Blvd
Saint Louis, MO 63141-6345
Phone (800) 325-3982
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 |
|---|---|---|---|
| 439 | MT | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1134864000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1104802537",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12647 OLIVE BLVD",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631416345",
"telephone_number": "800-325-3982"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "468 74TH ST N",
"address_2": "MALMSTROM AFB, HEALTH AND WELLNESS CENTER",
"city": "GREAT FALLS",
"state": "MT",
"postal_code": "594026780",
"telephone_number": "406-731-2404"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAILLET",
"first_name": "JACQUELINE",
"middle_name": "MARY",
"name_prefix": "Ms.",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-12-18",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MT",
"license": "439",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Great Falls, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.