Jerilyn Ann Jackson, R.D.

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

LDN00388 Issued in RI

Practice address

111 Brewster St
Pawtucket, RI 02860-4400

Phone

(401) 729-2360

Fax

(401) 729-2179

NPI assigned

Jul 6, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

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.

• South County Psychiatry LLC

  • Psychiatry Physician
  • North Kingstown, RI
  • NPI 1003454034

  Dietitian, Registered

  NPD
• Memorial Hospital

  • General Acute Care Hospital
  • Pawtucket, RI
  • NPI 1548696941
  NPD (past)
• Bridgewater Goddard Park Medical Associates, Inc.

  • Multi-Specialty Clinic/Center
  • Brockton, MA
  • NPI 1417932591
  NPD (past)
• Signature Healthcare Medical Group Inc

  • Internal Medicine Physician
  • Brockton, MA
  • NPI 1508804949
  NPD (past)

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785456000000",
    "number": "1306878079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 SCRABBLETOWN RD STE A",
            "city": "NORTH KINGSTOWN",
            "state": "RI",
            "postal_code": "028523638",
            "telephone_number": "401-343-4343",
            "fax_number": "401-296-3998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 BREWSTER ST",
            "city": "PAWTUCKET",
            "state": "RI",
            "postal_code": "028604400",
            "telephone_number": "401-729-2360",
            "fax_number": "401-729-2179"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1170 Pontiac Ave",
            "address_purpose": "LOCATION",
            "city": "Cranston",
            "state": "RI",
            "postal_code": "029207944",
            "country_code": "US",
            "telephone_number": "401-895-9937",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JERILYN",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "R.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-06",
        "last_updated": "2026-07-31",
        "certification_date": "2026-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "RI",
            "license": "LDN00388",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "2038776",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "20695-0",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CHIP",
            "identifier": "CP00404528",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ivoha Health & Consulting, LLC
• Barbara Jablow, MD
• Carissa May Jackson, LCSW
• Jamie Jackson, BEYOND HS
• Jan Meredith Jackson, M.A.
• Tyla Jackson
• Mohammed Jamali, PT
• Aimee R James, CNM, WHNP-BC
• Elizabeth James, MASTERS
• Richard James

• Registered Dietitian in Pawtucket, RI
• Providers in Pawtucket, RI by specialty
• Registered Dietitian in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 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.

Verify at the official NPI Registry.