Active NPI
Jacqueline Odette, DTR, CDM, CFPP
- Registered Dietetic Technician
- Fairgrove, MI
National Provider Identifier
1235743006
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietetic Technician
- License
- 86198282
- Practice address
- 2328 N Thomas Rd
Fairgrove, MI 48733-9569 - Phone
- (989) 233-2373
- NPI assigned
- Aug 31, 2020
- Last updated
- Aug 31, 2020
- 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 Dietetic Technician | 136A00000X | 86198282 | MI | Primary |
Addresses
Primary practice location
2328 N Thomas Rd
Fairgrove, MI 48733-9569
Mailing address
1285 Cleaver Rd
Caro, MI 48723-9241
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86198282 | MI | MD | Registered Dietetic Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1598832000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1598832000000",
"number": "1235743006",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1285 CLEAVER RD",
"city": "CARO",
"state": "MI",
"postal_code": "487239241"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2328 N THOMAS RD",
"city": "FAIRGROVE",
"state": "MI",
"postal_code": "487339569",
"telephone_number": "989-233-2373"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ODETTE",
"first_name": "JACQUELINE",
"credential": "DTR, CDM, CFPP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-08-31",
"last_updated": "2020-08-31",
"certification_date": "2020-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "136A00000X",
"taxonomy_group": "",
"desc": "Dietetic Technician, Registered",
"state": "MI",
"license": "86198282",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairgrove, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 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.