Active NPI
Jana Willis, MS RD LDN
- Registered Dietitian
- Bowling Green, KY
National Provider Identifier
1336495944
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- Practice address
- 730 Fairview Ave
Suite B1
Bowling Green, KY 42101-2367 - Phone
- (270) 901-3412
- Fax
- (270) 901-3413
- NPI assigned
- Aug 1, 2012
- Sex
- Female
- 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 | KY | Primary |
Addresses
Primary practice location
730 Fairview Ave
Suite B1
Bowling Green, KY 42101-2367
Mailing address
640 Continental Dr
#48
Bowling Green, KY 42103-6900
Phone (270) 901-3412
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)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1008 | SC | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| MNT, Inc. | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1343779200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1386028800000",
"number": "1336495944",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "640 CONTINENTAL DR",
"address_2": "#48",
"city": "BOWLING GREEN",
"state": "KY",
"postal_code": "421036900",
"telephone_number": "270-901-3412",
"fax_number": "270-901-3413"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "730 FAIRVIEW AVE",
"address_2": "SUITE B1",
"city": "BOWLING GREEN",
"state": "KY",
"postal_code": "421012367",
"telephone_number": "270-901-3412",
"fax_number": "270-901-3413"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIS",
"first_name": "JANA",
"credential": "MS RD LDN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-08-01",
"last_updated": "2013-12-03",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "KY",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bowling Green, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.