Mindful Fork Nutrition LLC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

Legal business name

MINDFUL FORK NUTRITION LLC

Practice address

4301 Burnet Rd Ste a
Austin, TX 78756-3317

Phone

(512) 980-0590

Fax

(512) 598-5306

NPI assigned

Jun 25, 2020

Organization subpart

No

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

Authorized official

Name

Jacqueline Ayoub, RDN, LDNPI 1285048272

Title

Owner

Phone

(512) 980-0590

Specialties & licenses 2

Addresses

Electronic endpoints 4

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jacqueline Ayoub

  • Registered Dietitian
  • Austin, TX
  • NPI 1285048272

  Dietitian, Registered

  NPD Authorized official

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

{
    "created_epoch": "1593043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593216000000",
    "number": "1366069338",
    "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": "787221935",
            "telephone_number": "512-980-0590"
        },
        {
            "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": "1602 Edgewood Ave",
            "address_purpose": "LOCATION",
            "city": "Austin",
            "state": "TX",
            "postal_code": "787221935",
            "country_code": "US",
            "telephone_number": "512-980-0590",
            "fax_number": "512-598-5306",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MINDFUL FORK NUTRITION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-25",
        "last_updated": "2020-06-27",
        "certification_date": "2020-06-27",
        "status": "A",
        "authorized_official_last_name": "AYOUB",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "512-980-0590",
        "authorized_official_credential": "RDN, LD"
    },
    "taxonomies": [
        {
            "code": "133NN1002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nutritionist, Nutrition, Education",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jacque@mindfulforknutrition.com",
            "affiliation": "N",
            "endpointDescription": "Encrypted HIPAA compliant email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1602 Edgewood Ave",
            "city": "Austin",
            "state": "TX",
            "country_code": "US",
            "postal_code": "787221935",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.practicebetter.com",
            "affiliation": "N",
            "endpointDescription": "EHR",
            "address_1": "1602 Edgewood Ave",
            "city": "Austin",
            "state": "TX",
            "country_code": "US",
            "postal_code": "787221935",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "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": []
}

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• 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.