Individual provider Active NPI

Jena Williams, RDN

  • Registered Dietitian
  • Burnsville, MN
National Provider Identifier
1477302651
Registry record updated May 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
4857 Issued in MN
Practice address
14551 Judicial Rd Ste 100
Burnsville, MN 55306-4991
Phone
(952) 898-5020
NPI assigned
May 18, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 18, 2024

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 4857 MN Primary

Addresses

Primary practice location

14551 Judicial Rd Ste 100
Burnsville, MN 55306-4991

Mailing address

10717 Austin St NE Apt 445
Blaine, MN 55449-2910
Phone (507) 380-6803

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251028000734 MN Practitioner - Registered Dietitian Or Nutrition Professional 4284123555 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Registered Dietitian Or Nutrition Professional
Education
Other, 2021
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

6385 Old Shady Oak Rd
Suite 250
Eden Prairie, MN 55344-0029

6385 Old Shady Oak Rd
Suite 250
Eden Prairie, MN 55344-7705

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4857MNMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Bushman Psychological Services LLC CurrentSince May 19, 2024 Accepting new patients
Necessary Nutrition LLC Dietitian, Registered CurrentSince Sep 1, 2025 Accepting new patients

Locations

14551 Judicial Rd
Ste 100
Burnsville, MN 55306
Phone (952) 898-5020

6385 Old Shady Oak Rd
Ste 250
Eden Prairie, MN 55344
Phone (612) 226-0907

11670 Fountains Dr N
Ste 200
Maple Grove, MN 55369
Phone (612) 355-0693

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1715990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715990400000",
    "number": "1477302651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10717 AUSTIN ST NE APT 445",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554492910",
            "telephone_number": "507-380-6803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14551 JUDICIAL RD STE 100",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553064991",
            "telephone_number": "952-898-5020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "JENA",
        "credential": "RDN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-05-18",
        "last_updated": "2024-05-18",
        "certification_date": "2024-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "MN",
            "license": "4857",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burnsville, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2024; 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.