Mary Yvonne McCormick, RD, CDE

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

ND 1658 Issued in FL

Practice address

820 Prudential Dr
Suite 416
Jacksonville, FL 32207-8210

Phone

(904) 202-1152

Fax

(904) 202-1152

NPI assigned

Dec 11, 2009

Last updated

Dec 11, 2009By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1260489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1260489600000",
    "number": "1215266713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 PRUDENTIAL DR STE 416",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322078206",
            "telephone_number": "904-202-1152",
            "fax_number": "904-202-2462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 PRUDENTIAL DR",
            "address_2": "SUITE 416",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322078210",
            "telephone_number": "904-202-1152",
            "fax_number": "904-202-1152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCORMICK",
        "first_name": "MARY",
        "middle_name": "YVONNE",
        "credential": "RD, CDE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-12-11",
        "last_updated": "2009-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "FL",
            "license": "ND 1658",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Barry Moore McCook, MD
• Tommie Ann McCormack, DPT
• Alexis Elaine McCormick
• Barrett Zachary McCormick, M.D.
• Benjamin Joseph McCormick, MD
• Sarah McCormick, LCSW
• Sarah Elisabeth McCormick, OTD,OTR/L
• Stephanie W. McCormick, PHARM.D.
• Timothy Joseph McCormick, DO
• McCoy Institute of Health

• Registered Dietitian in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Registered Dietitian in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.