Individual provider Active NPI

Jessica Lynn Enders, RD/LD

  • Registered Dietitian
  • Henderson, NV
National Provider Identifier
1427280874
Registry record updated Mar 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
34408DI-0 Issued in NV
Practice address
528 Sol de Sandia St
Henderson, NV 89015-6961
Phone
(770) 262-5568
NPI assigned
Aug 19, 2009
Last updated
Mar 21, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 21, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 34408DI-0 NV Primary

Addresses

Primary practice location

528 Sol de Sandia St
Henderson, NV 89015-6961

Mailing address

528 Sol de Sandia St
Henderson, NV 89015-6961
Phone (770) 262-5568

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230412001902 NV Practitioner - Registered Dietitian Or Nutrition Professional 4880069434 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Registered Dietitian Or Nutrition Professional
Education
Vanderbilt University School of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Childrens Lung SpecialistsGroup PAC ID 5991782971, 4 clinicians

Practice addresses (Care Compare)

3196 S Maryland Pkwy
Suite 209
Las Vegas, NV 89109-2313
Phone (702) 598-4411

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
34408DI-0NVMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Childrens Lung Specialists CurrentSince Apr 3, 2023 Accepting new patients

Locations

3196 S Maryland Pkwy
Ste 209
Las Vegas, NV 89109
Phone (702) 598-4411

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1250640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679356800000",
    "number": "1427280874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "528 SOL DE SANDIA ST",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890156961",
            "telephone_number": "770-262-5568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "528 SOL DE SANDIA ST",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890156961",
            "telephone_number": "770-262-5568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENDERS",
        "first_name": "JESSICA",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "RD/LD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-08-19",
        "last_updated": "2023-03-21",
        "certification_date": "2023-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NV",
            "license": "34408DI-0",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Henderson, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.