Active NPI
Jesse Jose Jackson
- Registered Dietitian
- Columbia, MO
National Provider Identifier
1306763933
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86466453
- Practice address
- 2005 Parkade Blvd
Columbia, MO 65202-3122 - Phone
- (573) 825-3695
- NPI assigned
- Jul 3, 2026
- Sex
- Male
- 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 Dietitian | 133V00000X | 86466453 | MO | Primary |
Addresses
Primary practice location
2005 Parkade Blvd
Columbia, MO 65202-3122
Mailing address
2005 Parkade Blvd
Columbia, MO 65202-3122
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1783036800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783036800000",
"number": "1306763933",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2005 PARKADE BLVD",
"city": "COLUMBIA",
"state": "MO",
"postal_code": "652023122"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2005 PARKADE BLVD",
"city": "COLUMBIA",
"state": "MO",
"postal_code": "652023122",
"telephone_number": "573-825-3695"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "JESSE",
"middle_name": "JOSE",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2026-07-03",
"last_updated": "2026-07-03",
"certification_date": "2026-07-03",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MO",
"license": "86466453",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbia, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.