Jacqueline Ayoub

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

DT82549 Issued in TX

Practice address

4301 Burnet Rd Ste a
Austin, TX 78756-3317

Phone

(512) 980-0590

Fax

(512) 598-5306

NPI assigned

Jun 17, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

• Mindful Fork Nutrition LLC

  • Registered Dietitian
  • Austin, TX
  • NPI 1366069338

  Dietitian, Registered

  NPD Authorized official

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

{
    "created_epoch": "1402963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593216000000",
    "number": "1285048272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1602 EDGEWOOD AVE",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "78722",
            "telephone_number": "512-980-0590",
            "fax_number": "512-598-5306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4301 BURNET RD STE A",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787563317",
            "telephone_number": "512-980-0590",
            "fax_number": "512-598-5306"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5900 Balcones Dr Ste 165",
            "address_purpose": "LOCATION",
            "city": "Austin",
            "state": "TX",
            "postal_code": "787314293",
            "country_code": "US",
            "telephone_number": "512-338-4500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1602 Edgewood Ave",
            "address_purpose": "LOCATION",
            "city": "Austin",
            "state": "TX",
            "postal_code": "78722",
            "country_code": "US",
            "telephone_number": "512-980-0590",
            "fax_number": "512-598-5306",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AYOUB",
        "first_name": "JACQUELINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-17",
        "last_updated": "2020-06-27",
        "certification_date": "2020-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "TX",
            "license": "DT8259",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "TX",
            "license": "DT82549",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LD LICENSE",
            "identifier": "DT82549",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jacque@mindfulforknutrition.com",
            "affiliation": "N",
            "address_1": "4301 Burnet Rd Ste A",
            "city": "Austin",
            "state": "TX",
            "country_code": "US",
            "postal_code": "787563317",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.practicebetter.com",
            "affiliation": "N",
            "address_1": "4301 Burnet Rd Ste A",
            "city": "Austin",
            "state": "TX",
            "country_code": "US",
            "postal_code": "787563317",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Gayle Yvonne Ayers, D.O.
• Rachel Aylor, PHARMD
• Sarah Elizabeth Ayoroa, MD
• Andrew Ashraf Ayoub
• Camille Ayoub, D.O.
• Debora L Ayres, D.D.S.
• Jennifer Lyn Ayres, PH.D.
• Haneen Aysha
• Erica Lavan Murphy Ayuso, LCSW
• Az Medical PLLC

• Registered Dietitian in Austin, TX
• Providers in Austin, TX by specialty
• Registered Dietitian in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 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.