Active NPI
Jessica Carny Tilton, RD
- Registered Dietitian
- Minneapolis, MN
National Provider Identifier
1679723688
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 2405
- Practice address
- 800 E 28TH St
Mail Route 11117
Minneapolis, MN 55407-3723 - Phone
- (612) 863-8631
- Fax
- (612) 863-7151
- NPI assigned
- Sep 26, 2008
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 2405 | MN | Primary |
Addresses
Primary practice location
800 E 28TH St
Mail Route 11117
Minneapolis, MN 55407-3723
Mailing address
6604 Gleason Rd
Edina, MN 55439-1128
Phone (952) 941-4903
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
- Credentials
- Medical Technician
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2405 | MN | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1222387200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1222387200000",
"number": "1679723688",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6604 GLEASON RD",
"city": "EDINA",
"state": "MN",
"postal_code": "554391128",
"telephone_number": "952-941-4903"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 E 28TH ST",
"address_2": "MAIL ROUTE 11117",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554073723",
"telephone_number": "612-863-8631",
"fax_number": "612-863-7151"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TILTON",
"first_name": "JESSICA",
"middle_name": "CARNY",
"name_prefix": "Mrs.",
"credential": "RD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-09-26",
"last_updated": "2008-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MN",
"license": "2405",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 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.