Kaylen McNamara James Jackson, R.D., L.D., C.D.E.

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

01021614 Issued in MN

Practice address

1415 Saint Francis Ave
Shakopee, MN 55379-3374

Phone

(952) 993-3742

NPI assigned

Feb 1, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Kaylen McNamara James Former name

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Park Nicollet Clinic

  • Family Medicine Physician
  • St Louis Park, MN
  • NPI 1780621904
  Medicare reassignment NPD
• Kaylen Jackson Nutrition LLC

  • Registered Dietitian
  • Edina, MN
  • NPI 1710632393

  Dietitian, Registered

  NPD Authorized official
• Park Nicollet Clinic

  • Family Medicine Physician
  • St Louis Park, MN
  • NPI 1063897593
  NPD

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

{
    "created_epoch": "1296518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466985600000",
    "number": "1225334709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVENUE SOUTH",
            "address_2": "MAIL STOP 21110Q",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55440",
            "telephone_number": "952-883-6212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 SAINT FRANCIS AVE",
            "city": "SHAKOPEE",
            "state": "MN",
            "postal_code": "553793374",
            "telephone_number": "952-993-3742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KAYLEN",
        "middle_name": "MCNAMARA JAMES",
        "name_prefix": "Ms.",
        "credential": "R.D., L.D., C.D.E.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-02-01",
        "last_updated": "2016-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "MN",
            "license": "01021614",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAYLEN",
            "last_name": "JAMES",
            "middle_name": "MCNAMARA",
            "credential": "R.D., L.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Inspirewellnessservices LLC
• Integrated Home and Community Living Services
• Irreplaceable Sober House
• Venkateshwaran K Iyer, MD
• Chantra-Lee Jackson
• Dick Jacobson, RPH
• Hilal Abdullahi Jama
• James R Jensen, DDS
• Anne E Jeffries
• Dawn Mersch Jenkins, MD

• Registered Dietitian in Shakopee, MN
• Providers in Shakopee, MN by specialty
• Registered Dietitian in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.