Active NPI
Jennifer Lind Womack, R.D., C.D.E.
- Registered Dietitian
- Fort Mohave, AZ
National Provider Identifier
1205931839
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 817192
- Practice address
- 5300 S. Highway 95 Ste a
Fort Mohave, AZ 86426 - Phone
- (928) 768-9496
- NPI assigned
- Sep 14, 2006
- Last updated
- Jul 21, 2022
- 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 | 817192 | AZ | Primary |
Addresses
Primary practice location
5300 S. Highway 95 Ste a
Fort Mohave, AZ 86426
Mailing address
P.0. Box 9479
Fort Mohave, AZ 86426
Phone (928) 768-9496
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| AZ0258900 | Other | AZ | BLUE CROSS BLUE SHIELD |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1205931839",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.0. BOX 9479",
"city": "FORT MOHAVE",
"state": "AZ",
"postal_code": "86426",
"telephone_number": "928-768-9496"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5300 S. HIGHWAY 95 STE A",
"city": "FORT MOHAVE",
"state": "AZ",
"postal_code": "86426",
"telephone_number": "928-768-9496"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOMACK",
"first_name": "JENNIFER",
"middle_name": "LIND",
"name_prefix": "Mrs.",
"credential": "R.D., C.D.E.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-14",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "AZ",
"license": "817192",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "AZ0258900",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Mohave, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.