Active NPI
Katherine M Jennison, RD LDN
- Registered Dietitian
- St Augustine, FL
National Provider Identifier
1144422700
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- ND5590
- Practice address
- 400 Health Park Blvd
St Augustine, FL 32086-5784 - Phone
- (904) 819-4404
- NPI assigned
- Jun 4, 2007
- Last updated
- May 19, 2011
- Sex
- Female
- Sole proprietor
- Yes
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 | ND5590 | FL | Primary |
Addresses
Primary practice location
400 Health Park Blvd
St Augustine, FL 32086-5784
Mailing address
87 Ponte Vedra Colony Cir
Ponte Vedra Beach, FL 32082-4710
Phone (978) 807-7205
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ND5590 | FL | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nourish, Inc. | Dietitian, Registered | 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, 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": "1180915200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1305763200000",
"number": "1144422700",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "87 PONTE VEDRA COLONY CIR",
"city": "PONTE VEDRA BEACH",
"state": "FL",
"postal_code": "320824710",
"telephone_number": "978-807-7205"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 HEALTH PARK BLVD",
"city": "ST AUGUSTINE",
"state": "FL",
"postal_code": "320865784",
"telephone_number": "904-819-4404"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JENNISON",
"first_name": "KATHERINE",
"middle_name": "M",
"credential": "RD LDN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-06-04",
"last_updated": "2011-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "FL",
"license": "ND5590",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Augustine, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.