Active NPI
Jessica Helen Thackray, RD
- Registered Dietitian
- Boone, NC
National Provider Identifier
1477677250
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- L002856
- Practice address
- 2359 Hy 105
Cdsa of the Blue Ridge
Boone, NC 28607 - Phone
- (828) 256-5391
- Fax
- (828) 265-5394
- NPI assigned
- Mar 19, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | L002856 | NC | Primary |
Addresses
Primary practice location
2359 Hy 105
Cdsa of the Blue Ridge
Boone, NC 28607
Mailing address
265 Watauga Dr
Boone, NC 28607-3853
Phone (828) 773-1069
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L002856 | NC | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174262400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1229385600000",
"number": "1477677250",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "265 WATAUGA DR",
"city": "BOONE",
"state": "NC",
"postal_code": "286073853",
"telephone_number": "828-773-1069"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2359 HY 105",
"address_2": "CDSA OF THE BLUE RIDGE",
"city": "BOONE",
"state": "NC",
"postal_code": "28607",
"telephone_number": "828-256-5391",
"fax_number": "828-265-5394"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THACKRAY",
"first_name": "JESSICA",
"middle_name": "HELEN",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-19",
"last_updated": "2008-12-16",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NC",
"license": "L002856",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boone, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.