Active NPI
Olivia Jackson, RD
- Registered Dietitian
- Valley, AL
National Provider Identifier
1689272759
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- Practice address
- 4800 48TH St
Valley, AL 36854-3666 - Phone
- (334) 710-0037
- NPI assigned
- Oct 12, 2020
- Last updated
- Nov 2, 2020
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | Primary | ||
| Pediatric Nutrition Registered Dietitian | 133VN1004X | |||
| Obesity and Weight Management Nutrition Registered Dietitian | 133VN1201X |
Addresses
Primary practice location
4800 48TH St
Valley, AL 36854-3666
Mailing address
4800 48TH St
Valley, AL 36854-3666
Other practice location 1
2422 Village Professional Dr
Opelika, AL 36801-2378
Phone (334) 582-6800
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | Cerner |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3111 | AL | MD | School Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1602460800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604275200000",
"number": "1689272759",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4800 48TH ST",
"city": "VALLEY",
"state": "AL",
"postal_code": "368543666"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4800 48TH ST",
"city": "VALLEY",
"state": "AL",
"postal_code": "368543666",
"telephone_number": "334-710-0037"
}
],
"practiceLocations": [
{
"address_1": "2422 Village Professional Dr",
"address_purpose": "LOCATION",
"city": "Opelika",
"state": "AL",
"postal_code": "368012378",
"country_code": "US",
"telephone_number": "334-582-6800",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JACKSON",
"first_name": "OLIVIA",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-10-12",
"last_updated": "2020-11-02",
"certification_date": "2020-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": null,
"license": null,
"primary": true
},
{
"code": "133VN1004X",
"taxonomy_group": "",
"desc": "Dietitian, Registered, Nutrition, Pediatric",
"state": null,
"license": null,
"primary": false
},
{
"code": "133VN1201X",
"taxonomy_group": "",
"desc": "Dietitian, Registered, Nutrition, Obesity and Weight Management",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "Cerner",
"affiliation": "N",
"address_1": "2422 Village Professional Dr",
"city": "Opelika",
"state": "AL",
"country_code": "US",
"postal_code": "368012378",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Valley, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.