Active NPI
Jennifer Louise Koslo, MS, RD, CSSD
- Registered Dietitian
- Phoenix, AZ
National Provider Identifier
1275708505
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 863062
- Practice address
- 5633 South 42ND Street
Phoenix, AZ 85040 - Phone
- (602) 363-4442
- NPI assigned
- Apr 28, 2008
- Last updated
- Apr 25, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nutrition Education Nutritionist | 133NN1002X | 863062 | ||
| Registered Dietitian | 133V00000X | 863062 | Primary |
Addresses
Primary practice location
5633 South 42ND Street
Phoenix, AZ 85040
Mailing address
1849 E Guadalupe Rd
Suite C101, Pmb149
Tempe, AZ 85283-3288
Phone (602) 363-4442
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
Care Compare profile
Medicare Care Compare- Specialty
- Registered Dietitian Or Nutrition Professional
- Education
- Other, 2000
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
13279 Kerrville Folkway
Austin, TX 78729-7842
500 Westover Dr
Sanford, NC 27330-8941
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nourish, Inc. | Dietitian, Registered | Past | Accepting new patients |
| Marjorie Nolan Cohn LLC | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1209340800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1240617600000",
"number": "1275708505",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1849 E GUADALUPE RD",
"address_2": "SUITE C101, PMB149",
"city": "TEMPE",
"state": "AZ",
"postal_code": "852833288",
"telephone_number": "602-363-4442"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5633 SOUTH 42ND STREET",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "85040",
"telephone_number": "602-363-4442"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOSLO",
"first_name": "JENNIFER",
"middle_name": "LOUISE",
"name_prefix": "Ms.",
"credential": "MS, RD, CSSD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-04-28",
"last_updated": "2009-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "133NN1002X",
"taxonomy_group": "",
"desc": "Nutritionist, Nutrition, Education",
"state": null,
"license": "863062",
"primary": false
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": null,
"license": "863062",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.