Active NPI
Jennifer Wilson
- Registered Dietitian
- Knoxville, TN
National Provider Identifier
1336806322
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- LDN0000002929
- Practice address
- 6450 Provision Cares Way
Knoxville, TN 37909-2544 - Phone
- (865) 566-3272
- NPI assigned
- Nov 24, 2021
- 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 | LDN0000002929 | TN | Primary |
Addresses
Primary practice location
6450 Provision Cares Way
Knoxville, TN 37909-2544
Mailing address
1627 Colonade Rd
Knoxville, TN 37922-6308
Phone (662) 934-1575
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LDN0000002929 | TN | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1637712000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1640044800000",
"number": "1336806322",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1627 COLONADE RD",
"city": "KNOXVILLE",
"state": "TN",
"postal_code": "379226308",
"telephone_number": "662-934-1575"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6450 PROVISION CARES WAY",
"city": "KNOXVILLE",
"state": "TN",
"postal_code": "379092544",
"telephone_number": "865-566-3272"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "JENNIFER",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-11-24",
"last_updated": "2021-12-21",
"certification_date": "2021-12-21",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "TN",
"license": "LDN0000002929",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Knoxville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.