Active NPI
Jacob Magnan, RD
- Registered Dietitian
- Colchester, VT
National Provider Identifier
1366813685
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 074.0115928
- Practice address
- 762 Bean Rd
Apartment 2
Colchester, VT 05446-6830 - Phone
- (484) 241-1189
- NPI assigned
- Oct 13, 2015
- Sex
- Male
- Sole proprietor
- Yes
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 | 074.0115928 | VT | Primary |
Addresses
Primary practice location
762 Bean Rd
Apartment 2
Colchester, VT 05446-6830
Mailing address
762 Bean Rd
Apartment 2
Colchester, VT 05446-6830
Phone (484) 241-1189
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 074.0115928 | VT | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1444694400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1444694400000",
"number": "1366813685",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "762 BEAN RD",
"address_2": "APARTMENT 2",
"city": "COLCHESTER",
"state": "VT",
"postal_code": "054466830",
"telephone_number": "484-241-1189"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "762 BEAN RD",
"address_2": "APARTMENT 2",
"city": "COLCHESTER",
"state": "VT",
"postal_code": "054466830",
"telephone_number": "484-241-1189"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAGNAN",
"first_name": "JACOB",
"credential": "RD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-10-13",
"last_updated": "2015-10-13",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "VT",
"license": "074.0115928",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Colchester, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.