Tamela Jeanine Mack, RD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

DI682 Issued in DC

Practice address

417 Peabody Street Northeast
Washington, DC 20011-1645

Phone

(202) 529-0582

Fax

(202) 529-0220

NPI assigned

Feb 1, 2010

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1264982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622592000000",
    "number": "1407188428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "417 PEABODY STREET NORTHEAST",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200111645",
            "telephone_number": "202-529-0582",
            "fax_number": "202-529-0220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "417 PEABODY STREET NORTHEAST",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200111645",
            "telephone_number": "202-529-0582",
            "fax_number": "202-529-0220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "TAMELA",
        "middle_name": "JEANINE",
        "credential": "RD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-02-01",
        "last_updated": "2021-06-02",
        "certification_date": "2021-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "FL",
            "license": "ND3748",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "MD",
            "license": "DO2317",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "DC",
            "license": "DI682",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggateways",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "417 Peabody Street Northeast",
            "city": "Washington",
            "state": "DC",
            "country_code": "US",
            "postal_code": "200111645",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Quashawn Christopher Mack
• Qutina S Mack, PHARM D
• Selena Mack
• Shantelle Mack
• Talia Joy Mack
• Vonetta Mack
• Crystal Mackabee
• April Mackall
• Desmond Mackall, MS
• Latisha Mackall

• Registered Dietitian in Washington, DC
• Providers in Washington, DC by specialty
• Registered Dietitian in District of Columbia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 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.

Verify at the official NPI Registry.