Active NPI
Jeni Diane Tackett, RD
- Registered Dietitian
- East Moline, IL
National Provider Identifier
1366819690
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 876463
- Practice address
- 3928 172ND St N
East Moline, IL 61244-9728 - Phone
- (309) 230-9517
- NPI assigned
- Aug 21, 2015
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 876463 | IL | |
| Registered Dietitian | 133V00000X | 876463 | IA | Primary |
Addresses
Primary practice location
3928 172ND St N
East Moline, IL 61244-9728
Mailing address
3928 172ND St N
East Moline, IL 61244-9728
Phone (309) 230-9517
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 |
|---|---|---|---|
| 876463 | IA | MD | Registered Dietitian |
| 876463 | IL | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1440115200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1440115200000",
"number": "1366819690",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3928 172ND ST N",
"city": "EAST MOLINE",
"state": "IL",
"postal_code": "612449728",
"telephone_number": "309-230-9517"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3928 172ND ST N",
"city": "EAST MOLINE",
"state": "IL",
"postal_code": "612449728",
"telephone_number": "309-230-9517"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TACKETT",
"first_name": "JENI",
"middle_name": "DIANE",
"name_prefix": "Mrs.",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-08-21",
"last_updated": "2015-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IL",
"license": "876463",
"primary": false
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IA",
"license": "876463",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in East Moline, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 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.