Jacqueline Marie Humpherys, RD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

807654 Issued in ID

Practice address

5183 Saddle Strap Way
Pinetop, AZ 85935-7535

Phone

(928) 369-1111

NPI assigned

Sep 25, 2008

Last updated

Sep 25, 2008By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Northeastern Utah Medical Group

  • Family Medicine Physician
  • Roosevelt, UT
  • NPI 1982664199
  Medicare reassignment NPD
• Uintah Basin Medical Center

  • General Acute Care Hospital
  • Roosevelt, UT
  • NPI 1871556217
  Medicare reassignment NPD
• Northeastern Utah Medical Group

  • Durable Medical Equipment & Medical Supplies
  • Roosevelt, UT
  • NPI 1740482009
  NPD
• Uintah Basin Medical Center

  dba Uintah Basin Healthcare Vernal Pharmacy

  • Community/Retail Pharmacy
  • Vernal, UT
  • NPI 1285420414
  NPD

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

{
    "created_epoch": "1222300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222300800000",
    "number": "1447400437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5183 SADDLE STRAP WAY",
            "city": "PINETOP",
            "state": "AZ",
            "postal_code": "859357535",
            "telephone_number": "928-369-1111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5183 SADDLE STRAP WAY",
            "city": "PINETOP",
            "state": "AZ",
            "postal_code": "859357535",
            "telephone_number": "928-369-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUMPHERYS",
        "first_name": "JACQUELINE",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "RD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-09-25",
        "last_updated": "2008-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "ID",
            "license": "807654",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael James Foote, DO
• Four Pillars Recovery LLC
• H&L Medical Specialist Inc
• Jonathan Hanridge, D.D.S
• Scott Hanson, PAC
• Wanyou Israel, CNA
• K&L Transport LLC
• Christina Marie Kelley, DSW, LCSW, LISAC
• Ladys Choice LLC
• Kimberly J Marbello, PHARM.D.

• Registered Dietitian in Pinetop, AZ
• Providers in Pinetop, AZ by specialty
• Registered Dietitian in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.