Michelle Jackson, MS, RD, CDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

003365-01 Issued in NY

Practice address

500 Bergen Ave
Bronx, NY 10455-4048

Phone

(718) 401-5175

NPI assigned

Mar 18, 2020

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)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1584489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584489600000",
    "number": "1215563689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 MELBOURNE AVE",
            "city": "MAMARONECK",
            "state": "NY",
            "postal_code": "105432726",
            "telephone_number": "914-777-1809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 BERGEN AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104554048",
            "telephone_number": "718-401-5175"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "565 Morris Ave",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104514738",
            "country_code": "US",
            "telephone_number": "929-360-0906",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MICHELLE",
        "credential": "MS, RD, CDN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-03-18",
        "last_updated": "2020-03-18",
        "certification_date": "2020-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": "NY",
            "license": "003365-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Loretta Frances Jackson, MSED
• Mark A Jackson, MD
• Matthew Wesley Jackson, DO
• Melissa R Jackson, LMSW
• Michael Jackson, CASAC
• Natasha C Jackson, MD
• Nyesha Alexis Jackson, LMSW
• Octavia Mary Jackson
• Renee Jackson
• Shauna Jackson

• Registered Dietitian in Bronx, NY
• Providers in Bronx, NY by specialty
• Registered Dietitian in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2020; 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.