Active NPI
Jeffery Lee Heileson, RD, LD
- Registered Dietitian
- Fort Campbell, KY
National Provider Identifier
1124354204
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- LD003650
- Practice address
- 650 Joel Dr
Fort Campbell, KY 42223-5318 - Phone
- (270) 956-0621
- NPI assigned
- Oct 26, 2009
- Sex
- Male
- 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 | LD003650 | GA | Primary |
Addresses
Primary practice location
650 Joel Dr
Fort Campbell, KY 42223-5318
Mailing address
1501 Mutual Dr
Clarksville, TN 37042-7092
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 |
|---|---|---|---|
| LD003650 | GA | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1256515200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1378166400000",
"number": "1124354204",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1501 MUTUAL DR",
"city": "CLARKSVILLE",
"state": "TN",
"postal_code": "370427092"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "650 JOEL DR",
"city": "FORT CAMPBELL",
"state": "KY",
"postal_code": "422235318",
"telephone_number": "270-956-0621"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HEILESON",
"first_name": "JEFFERY",
"middle_name": "LEE",
"name_prefix": "Mr.",
"credential": "RD, LD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-10-26",
"last_updated": "2013-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "GA",
"license": "LD003650",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Campbell, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.