Jackie Carlson, Rd, LDN, Cde Diabetes Consultant, LLC

Primary specialty

Metabolic Nutrition Registered DietitianTaxonomy code 133VN1006X

Legal business name

JACKIE CARLSON, RD, LDN, CDE DIABETES CONSULTANT, LLC

Practice address

4867 College St
Ashville, NY 14710-9603

Phone

(716) 499-1049

NPI assigned

Aug 15, 2019

Organization subpart

No

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

Authorized official

Name

Jacqueline Carlson, RD, LDN, CDE

Title

Owner

Phone

(716) 499-1049

Specialties & licenses 1

Addresses

Electronic endpoints 1

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

{
    "created_epoch": "1565827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660521600000",
    "number": "1487200358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4867 COLLEGE ST",
            "city": "ASHVILLE",
            "state": "NY",
            "postal_code": "147109603",
            "telephone_number": "716-499-1049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4867 COLLEGE ST",
            "city": "ASHVILLE",
            "state": "NY",
            "postal_code": "147109603",
            "telephone_number": "716-499-1049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKIE CARLSON, RD, LDN, CDE DIABETES CONSULTANT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-15",
        "last_updated": "2022-08-15",
        "certification_date": "2022-08-15",
        "status": "A",
        "authorized_official_last_name": "CARLSON",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "716-499-1049",
        "authorized_official_credential": "RD, LDN, CDE"
    },
    "taxonomies": [
        {
            "code": "133VN1006X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dietitian, Registered, Nutrition, Metabolic",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "ASHVILLE",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "4867 College St",
            "city": "Ashville",
            "state": "NY",
            "country_code": "US",
            "postal_code": "147109603",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2022; 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.