Active NPI
Jackie Lennett Peterson, RD CDCES
- Registered Dietitian
- Pleasant Hill, CA
National Provider Identifier
1194289983
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86100784
- Practice address
- 213 Ilene Dr
Pleasant Hill, CA 94523-2226 - Phone
- (925) 819-0414
- NPI assigned
- Jan 25, 2019
- 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 | 86100784 | CA | Primary |
Addresses
Primary practice location
213 Ilene Dr
Pleasant Hill, CA 94523-2226
Mailing address
1888 Berkeley Way Apt 306
Berkeley, CA 94703-1684
Phone (925) 819-0414
Other names 1
- Jackie Hanna Lennett
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 |
|---|---|---|---|
| 86100784 | CA | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lifeweight Nutrition Programs | Current | Accepting new patients | |
| Native American Health Center, Inc | Past | Accepting new patients | |
| Fay Nutrition | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- Obesity and Weight Management Nutrition Registered Dietitian
- Alamo, CA
- NPI 1790558906
-
- Federally Qualified Health Center (FQHC)
- San Francisco, CA
- NPI 1669642914
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1548374400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1691971200000",
"number": "1194289983",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1888 BERKELEY WAY APT 306",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947031684",
"telephone_number": "925-819-0414"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "213 ILENE DR",
"city": "PLEASANT HILL",
"state": "CA",
"postal_code": "945232226",
"telephone_number": "925-819-0414"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "JACKIE",
"middle_name": "LENNETT",
"credential": "RD CDCES",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-01-25",
"last_updated": "2023-08-14",
"certification_date": "2023-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "CA",
"license": "86100784",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JACKIE",
"last_name": "LENNETT",
"middle_name": "HANNA",
"credential": "RD CDCES",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Pleasant Hill, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.