Jacquelyn K Phillips, LD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

LD.08329 Issued in OH

Practice address

354 Neff Dr
Canfield, OH 44406-1349

Phone

(330) 651-7571

NPI assigned

Feb 21, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

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.

• Nourish, Inc.

  • Registered Dietitian
  • Austin, TX
  • NPI 1558097824

  Dietitian, Registered

  Medicare reassignment NPD
• Practically Well Nutrition LLC

  • Registered Dietitian
  • East Liverpool, OH
  • NPI 1407615487

  Dietitian, Registered

  NPD Authorized official

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

{
    "created_epoch": "1550707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714003200000",
    "number": "1245797737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "354 NEFF DR",
            "city": "CANFIELD",
            "state": "OH",
            "postal_code": "444061349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "354 NEFF DR",
            "city": "CANFIELD",
            "state": "OH",
            "postal_code": "444061349",
            "telephone_number": "330-651-7571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "JACQUELYN",
        "middle_name": "K",
        "credential": "LD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-02-21",
        "last_updated": "2024-04-25",
        "certification_date": "2024-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "OH",
            "license": "LD.08329",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Peterson, RN
• Gianna Elizabethh Petrella
• Monica Carol Petrilla, LISW-S
• Alyssa Phillips
• Cliff Delmar Phillips
• Tamara Lynne Pierson
• Agustina Pinto Gonzalez
• Candace D Pipino, M.S. CCC-SLP
• Taylor Nicole Pipoly
• Anita M Pirone, PCC

• Registered Dietitian in Canfield, OH
• Providers in Canfield, OH by specialty
• Registered Dietitian in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2024; 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.