Active NPI
Jessica Danielle Russell
- Registered Dietitian
- Lumberton, NC
National Provider Identifier
1679154140
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- L005874
- Practice address
- 300 W 27TH St
Lumberton, NC 28358-3075 - Phone
- (910) 671-5000
- NPI assigned
- Apr 16, 2021
- 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 | L005874 | NC | Primary |
Addresses
Primary practice location
300 W 27TH St
Lumberton, NC 28358-3075
Mailing address
635 Marshtree LN Unit 301
Fayetteville, NC 28314-5550
Phone (919) 818-4876
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 |
|---|---|---|---|
| L005874 | NC | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1618531200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1618531200000",
"number": "1679154140",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "635 MARSHTREE LN UNIT 301",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283145550",
"telephone_number": "919-818-4876"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 W 27TH ST",
"city": "LUMBERTON",
"state": "NC",
"postal_code": "283583075",
"telephone_number": "910-671-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "JESSICA",
"middle_name": "DANIELLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-04-16",
"last_updated": "2021-04-16",
"certification_date": "2021-04-16",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NC",
"license": "L005874",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lumberton, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.