Active NPI
Jodi Anne Fulayter, RD
- Registered Dietitian
- Joliet, IL
National Provider Identifier
1629107495
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 164003007
- Practice address
- 2902 Campbell St
Joliet, IL 60435-6492 - Phone
- (708) 261-3463
- Fax
- (815) 744-2707
- NPI assigned
- Mar 5, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nutritionist | 133N00000X | 164003007 | IL | |
| Registered Dietitian | 133V00000X | 164003007 | IL | Primary |
Addresses
Primary practice location
2902 Campbell St
Joliet, IL 60435-6492
Mailing address
2902 Campbell St
Joliet, IL 60435-6492
Phone (708) 261-3463
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 09932114 | Other | IL | BLUE CROSS BLUE SHIELD |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173052800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1691539200000",
"number": "1629107495",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2902 CAMPBELL ST",
"city": "JOLIET",
"state": "IL",
"postal_code": "604356492",
"telephone_number": "708-261-3463",
"fax_number": "815-744-2707"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2902 CAMPBELL ST",
"city": "JOLIET",
"state": "IL",
"postal_code": "604356492",
"telephone_number": "708-261-3463",
"fax_number": "815-744-2707"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULAYTER",
"first_name": "JODI",
"middle_name": "ANNE",
"name_prefix": "Mrs.",
"credential": "RD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-05",
"last_updated": "2023-08-09",
"certification_date": "2023-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "133N00000X",
"taxonomy_group": "",
"desc": "Nutritionist",
"state": "IL",
"license": "164003007",
"primary": false
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IL",
"license": "164003007",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "09932114",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Joliet, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.