Active NPI
Jennifer Deboer Roark, RD LD
- Registered Dietitian
- Portland, OR
National Provider Identifier
1619008190
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 733
- Practice address
- 4552 SW Nevada St
Portland, OR 97219-1548 - Phone
- (971) 235-4723
- NPI assigned
- Mar 8, 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 | 733 | OR | Primary |
Addresses
Primary practice location
4552 SW Nevada St
Portland, OR 97219-1548
Mailing address
4552 SW Nevada St
Portland, OR 97219-1548
Phone (971) 235-4723
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)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fay Nutrition | Dietitian, Registered | Past | Accepting new patients |
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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173312000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1759276800000",
"number": "1619008190",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4552 SW NEVADA ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972191548",
"telephone_number": "971-235-4723"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4552 SW NEVADA ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972191548",
"telephone_number": "971-235-4723"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROARK",
"first_name": "JENNIFER",
"middle_name": "DEBOER",
"credential": "RD LD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-08",
"last_updated": "2025-10-01",
"certification_date": "2025-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "OR",
"license": "733",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.